Evidence-Based Analysis of Removal of Orthopaedic Implants in the Pediatric Population

Background: Requested project of the Pediatric Orthopaedic Society of North America Evidenced-Based Medicine Committee. Methods: The English literature was systematically reviewed for scientific evidence supporting or disputing the common practice of elective removal of implants in children. Results: Several case series reported implant removal, but none contained a control group with retained implants. No articles reported long-term outcomes of retained implants in large numbers. Several small series describe complications associated with retained implants without evidence of causation. The existing literature was not amenable to a meta-analysis. By compiling data from the literature, it is possible to calculate a complication rate of 10% for implant removal surgery. The complication rate for removal of implants placed for slipped capital femoral epiphysis is 34%. Articles regarding postmarket implant surveillance and basic science were also reviewed. Conclusions: There is no evidence in the current literature to support or refute the practice of routine implant removal in children.