Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.

Miho J. Tanaka, MD, is a board-certified orthopedic surgeon who specializes in the treatment of sports medicine injuries.

While removing old hardware implanted in the body may seem straightforward, it can be one of the more challenging orthopedic procedures. In fact, many orthopedic surgeons describe hardware removal to new trainees and residents to be "the most difficult procedure."

In reality, hardware removal is probably not the most difficult surgery—complex spine surgery, correction of congenital deformities, reconstruction of damaged joints—are all difficult, time-consuming surgical procedures. However, hardware removal surgery often lulls the unsuspecting surgeon, and patient, into thinking the surgery will be quick and easy. While it may turn out to be simple, hardware removal surgery has the propensity to be much more challenging than anticipated.

In the vast majority of patients with metal in the body, there is no need to remove the metal. Metal implants are generally designed to remain in place forever. However, there are some circumstances where metal should be removed. These include temporary metal devices only intended to be in the body for a short time, loose metal, or metal that may need to be removed to allow for additional surgery.

The bottom line is, there should always be a good reason to remove metal from the body because needless hardware removal can open the door to possible complications of surgery.

There are times when hardware removal can lead to significant benefits. When implanted metal is causing interference with normal joint mobility and function, or if metal implants are causing pain or irritation to soft-tissues, their removal can be beneficial.

In some cases, the hardware is routinely removed to prevent possible problems, and in other cases, the metal is only removed if it begins to cause a problem. There are also times when hardware removal becomes impossible.

This is often the case when there is a broken metal implant inside the body, which can be normal or expected in some cases after the surrounding bone has healed, and not necessarily a problem for the patient.

The reality is, most metal implants can be removed, but many don't have to be. There is always potential that what is seemingly going to be a simple, straight-forward surgical procedure may become much more complicated. For that reason, patients should be wary of a hardware removal surgery, and make sure it is necessary and worth the risks.

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