Orthopedic bone screws are specialized medical devices used to stabilize fractured bones or aid in bone fusion. These screws, often made from biocompatible materials like stainless steel or titanium, are designed to hold bone fragments in their correct anatomical position, promoting proper healing. While many patients retain these implants permanently, their removal becomes necessary in common situations. Removal decisions often depend on factors like patient symptoms and bone healing.
Why Bone Screws Are Removed
Bone screws are removed for various reasons, often after the bone has healed and the hardware has served its purpose. Pain or discomfort directly caused by the implant is a common reason. This occurs if the screw irritates surrounding soft tissues or becomes prominent, felt under the skin, especially in areas with thin tissue coverage like the ankle or collarbone.
Infection at the surgical site, though less common, is another reason for hardware removal, as it requires removal to eliminate the infection. Mechanical issues like screw breaking or loosening also necessitate removal, as these can compromise bone stability. In younger patients, hardware removal may prevent problems with future bone growth. Once the bone has recovered, removal is often an elective procedure, providing symptom relief and improving mobility.
The Surgical Removal Process
The surgical removal of bone screws is a less invasive procedure than the initial surgery to place them. Patients typically receive local, regional, or general anesthesia, depending on the number and location of screws, and patient preference. General anesthesia keeps the patient asleep, while local or regional anesthesia numbs only the surgical area, allowing the patient to remain awake.
During the procedure, the surgeon usually makes an incision along the original surgical scar to access the hardware. Any scar tissue around the screws may also be removed. Specialized instruments are then used to unscrew and extract the hardware. After the screws are removed, the incision is closed with stitches, staples, or surgical glue, and a dressing is applied to prevent infection. The procedure typically ranges from 15 to 75 minutes, with many patients able to go home the same day.
Recovering After Screw Removal
Recovery after bone screw removal is quicker and less involved than the initial surgery. Patients can expect some pain and swelling around the incision site, which improves within a few days, though discomfort may persist for several weeks. Pain medication may be prescribed, and ice and elevation of the affected area can help reduce swelling.
Wound care involves keeping the incision clean and dry, with specific instructions from the surgeon regarding dressing changes and showering. Activity restrictions vary depending on the location of the removed hardware and individual healing progress. While some weight-bearing may be allowed almost immediately, strenuous activities and contact sports are avoided for several weeks to months to allow the bone to regain strength. Physical therapy may be recommended to restore range of motion and strength, contributing to a smoother return to daily activities.
What Happens to the Bone After Screw Removal
After bone screws are removed, small holes are left in the bone where the implants were. These holes indicate areas previously occupied by screw threads. Initially, the bone around these holes may be weaker, making it more susceptible to fracture if subjected to significant stress.
The bone has a remarkable ability to heal and remodel itself. Over time, new bone tissue gradually grows into and fills these empty spaces. This process involves specialized bone cells, osteoblasts, which lay down new bone material. Blood vessels also grow into the site, providing nutrients for this repair. While some healing may occur within weeks, complete filling of the screw holes and restoration of full bone strength can take several months, often two to four months or more, depending on the individual and the size of the holes. During this period, avoiding high-impact activities ensures the bone heals properly without complications.