6 years too late to have hardware removed?

[Douglas_Firs]

I have a plate and 7 screws in right knee. I believe the hardware is causing most of the tightness/pain and at least part of the 5 degree ROM extension defecit in my knee that has never abated since my TPF IV surgery in 2017.

Ortho surgeon always told me the he 'didn't like taking hardware out' as a policy and said my hardware shouldn't cause me any ROM or pain difficulties. But now I am pretty convinced it is the metal creating the pain/tighntess and inability to 'lock out' my knee.

Will it be more trouble than it is worth, I wonder. I also had nerve numbness after my original ORIF surgery for TPF in 2017 which lingered for almost 2 years, Would cutting the old incision open again bring on another 2+ years of lower leg numbness?

[The_KNEEguru]

You may find some answers here - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2552942/

See "The average time until removal was 25.19 months (range 5.29–77.62 mo)."...

[Douglas_Firs]

KNEE-guru,

Thank you very much for sharing this information, and for all that you do here on the board. This place is the best on the internet.

The study is very interesting, though it only involves a small number of people and excludes quite a few who 'dropped out'.

Generally speaking, it seems a clear majority of people on kneeguru have no regrets about hardware removal, and some claim it improved their ROM significantly.

I think it makes intuitive sense to have the hardware out after it has served its purpose. But my OS was adamant that it would not benefit me and would have no effect on my ROM. But with the wisdom of hindsight, I see that OS reluctance is often based on factors other than getting optimal results for patients, and different OS often hold completely opposing views regarding hardware removal and other matters.

At 6 years post-surgery, I am at the outside edge of the above study's distribution. I wonder if it is any more traumatic to root out the screws from the bone after 6 years, rather than when the screw placements are fresh at, say, 6 months. I wish my OS had just offered to remove it like so many other OS do.

He really let me down by

1. Not stressing the URGENCY of gaining full extension ASAP post-surgery
2. Not intervening when I failed to regain extension, by doing MUA, offering other guidance
3. Not referring me to someone who could do LOA, etc, to achieve full ROM after 1-3 painful, hobbled years had passed without full ROM

So frustrating to think that 6 years of misery could potentially have been avoided.

Thank you again for everything.

[The_KNEEguru]

Thank you for the kind words.
Yes, it would be more traumatic now that at an earlier date because there may be some bony overgrowth at the edges of the hardware. Also I imagine the bone might not be as strong as it might be if it had been subjected to normal stresses all these years.

This second paper might give you a different perspective - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170248/

Why not ask about investigating the situation perhaps with a CT scan so that you are better informed about the exact situation in your own limb?

[The_KNEEguru]

It is an old thread but I am giving you the link just for your interest - /forum/viewtopic.php?t=39084

[The_KNEEguru]

This is a rather old diary for an high tibial osteotomy with hardware removal - /forum/viewtopic.php?t=45486
Just for your interest.

[Douglas_Firs]

KNEEguru,

Thank you so much. I am reading the second study and the archived threads you linked above with great interest.

I also agree with your suggestion about the CT/MRI. My immediate plan is to insist on an MRI/CT to determine definitively what is causing my knee contracture. Although it seems that it is likely scar (fibrosis) build up that is to blame, as I understand it, it may alternatively be a bad graft, cyclops lesion, misalignment, or something else. I have never been offered a CT/MRI by any of the 4 OS I have consulted since my TPF IV surgery in 2017. So getting certainty is step 1.

Step 2 is then to begin consulting via telemedicine with one of the arthrofibrosis/knee extension specialists in the kneeguru.co.uk 'Who's Who' doctor directory. I will need to travel to have surgery done, as no one in Florida seems familiar at all with treating fibrosis contracture.

On the positive side, I do not think I'm dealing with the more dangerous form of arthrofibrosis, the 'hot' and irritable kind that seems to be part of an immunological disorder. My contracture has never been 'painful' when probed or stretched, nor has it burned. It simply feels like the knee is filled with glue, w/ a hard STOP a few degrees short of full extension (and flexion, as well).

I will keep posting about my progress on kneeguru.co. I love this site. It has helped me so much. I think the level of discussion here is much higher than at any other available knee/arthrofibrosis resource.

Thank you.