Most orthopaedic implants are designed to remain in the body permanently. Some temporary implants are routinely removed, while others are only removed if they cause symptoms, interfere with movement or create other problems.
One of the most common questions I am asked as an orthopaedic surgeon is, "Will I need to have the plates and screws removed?" Whether you have had a plate, screws, rods or wires inserted after an injury, it is natural to wonder whether another operation will eventually be needed to remove them.
The answer depends on why the implant was inserted, where it is located and whether it is causing any problems. Modern orthopaedic implants are made from biocompatible materials and, in many situations, are intended to remain in the body for life. However, there are important exceptions, and in some cases implant removal is recommended or may be chosen after discussing the potential benefits and risks with your surgeon.
Permanent and Temporary Implants
Not all orthopaedic implants are designed with the same purpose.
Some implants are intended to become a permanent part of the body. Examples include total knee replacement, hip replacement and many other joint replacement implants. Once these implants are functioning well and well fixed to the bone, they are normally left in place indefinitely.
Other implants are intended to be temporary. Smooth Kirschner wires (K-wires) are commonly removed after fractures or corrective procedures, particularly when they protrude through the skin (by design) or their ends may irritate surrounding tissues. Some temporary bridging plates are also removed after healing so that movement across the temporarily stabilised joint can be restored.
Plates, screws and intramedullary nails used to fix fractures sit somewhere in between. In adults, these are generally safe to leave in place after the fracture has healed, but they can be removed if there is an appropriate reason.
When Can Implants Stay Forever?
For most adults, a well-positioned fracture implant that is not causing symptoms does not automatically need to be removed.
Implant-removal surgery is itself another operation and may involve infection, nerve injury, wound problems, broken screws or refracture. For this reason, the decision is generally individual rather than based on a rule that all metal must eventually be removed.
The evidence around routine removal is particularly variable between adults and children. A review of implant removal in children, for example, found insufficient evidence either to support or reject routine removal across all implant types, while noting that K-wires and prominent intramedullary devices are more commonly removed than asymptomatic plates and screws. PubMed: Implant removal in children
Modern hip and knee replacements, by contrast, are specifically designed for long-term implantation.
Why Can Plates and Screws Become Uncomfortable?
One common reason for considering removal is prominence beneath the skin.
Some parts of the skeleton have very little padding between the bone and the skin. Examples include the outer ankle, collarbone, elbow and upper shin. In these locations, a plate or screw head may be easy to feel and can sometimes become uncomfortable with shoes, kneeling, leaning on the area or other activities.
Implants close to moving structures can also occasionally irritate tendons, muscles or joints. An ankle plate, for example, may become noticeable within footwear, while implants around the wrist or other mobile areas can sometimes irritate nearby tendons.
This does not necessarily mean the implant has failed. Sometimes the implant is functioning exactly as intended but becomes troublesome simply because of its location.
Does Removing a Painful Implant Help?
It can, particularly when the symptoms can be clearly localised to the implant.
A prospective study of patients with painful fracture fixation implants found substantial improvement after removal: mean pain scores fell from 5.5 to 1.3 at one year, and 53% of patients reported complete resolution of pain. The researchers first excluded other explanations such as infection or failure of the fracture to heal. PubMed: Removal of painful orthopaedic implants after fracture union
Another prospective study of elective implant removal found that pain improved in 91% of patients who initially complained of pain, although minor complications also occurred. PubMed: Is Elective Implant Removal after Fracture Healing Beneficial?
Results are not guaranteed. Other studies, particularly around the ankle, have found that some patients continue to experience pain even after the metal has been removed. Implant removal is therefore most predictable when the symptoms appear genuinely related to prominent or irritating hardware rather than unexplained pain. PubMed: Hardware-related pain after ankle fracture fixation
Can the Body Be Allergic to an Implant?
Occasionally—but this is much less straightforward than ordinary skin allergy.
Orthopaedic implants may contain titanium, stainless steel, cobalt, chromium or nickel, depending on the implant. Metal hypersensitivity reactions to orthopaedic implants have been described, but clinically important reactions appear to be uncommon.
Possible symptoms include dermatitis, persistent unexplained pain or swelling. However, these symptoms have many much more common causes, particularly after a joint replacement.
A major review of metal hypersensitivity concluded that reactions can occur but that diagnosis is difficult. A positive skin patch test does not, by itself, prove that an implant is responsible for a patient's symptoms. PubMed: Metal Hypersensitivity Reactions to Orthopedic Implants
For this reason, suspected metal hypersensitivity is generally considered after other causes such as infection, loosening or mechanical problems have been investigated.
Can I Simply Choose to Have the Metal Removed?
Sometimes.
Once a fracture has completely healed, a patient may prefer removal because the implant remains uncomfortable, feels prominent or simply bothers them.
Patient preference can reasonably form part of the discussion, but removal is not risk-free. The potential benefit needs to be balanced against another anaesthetic, wound complications, infection, nerve injury and the possibility of broken or retained screws.
In one study of 332 patients undergoing implant removal, pain and impaired function were among the common reasons for removal, and most patients reported that they would undergo the procedure again. However, complications and persistent symptoms also occurred, reinforcing that removal should remain an individual decision rather than a routine procedure. PubMed: Metal implant removal—benefits and drawbacks
Does Metal Become Harder to Remove Over Time?
This is a particularly interesting question, and there is evidence that it sometimes can.
Bone can gradually grow around plates and screws. With some titanium fixation systems, screws may also become difficult to remove because of stripping, breakage or cold welding, where the screw head becomes tightly bonded to the plate.
A 2024 study examined 157 patients undergoing titanium plate removal. Bone overgrowth requiring removal was found around 8.2% of plates, and 7.6% of operations required specialised extraction tools. Importantly, difficult removals had been implanted for significantly longer—an average of 3.7 years compared with 1.1 years for uncomplicated removals. PubMed: How difficult is titanium plate and screw implant removal?
Joint replacements provide an even clearer example. Many modern uncemented hip replacement components are deliberately designed with porous or specially treated surfaces that encourage bone ongrowth or ingrowth. This biological fixation is desirable because it helps the implant remain stable for many years.
If revision surgery is eventually required, however, firmly fixed components sometimes require specialised techniques to separate them from the bone.
This does not mean an implant should be removed early simply because it might become more difficult to remove later. If an implant is functioning well and was designed to remain permanently, increasing fixation over time is usually a benefit rather than a problem.
When Is Implant Removal More Likely to Be Needed?
Removal may be considered when:
- A temporary implant such as a K-wire has completed its purpose.
- A temporary bridging implant is restricting movement that now needs to be restored.
- A plate or screw is persistently prominent or painful beneath the skin.
- An implant is irritating a tendon or interfering with joint movement.
- Infection involves the implant.
- The implant has loosened, migrated or broken.
- Another operation requires the implant to be removed.
- Persistent symptoms appear clearly attributable to the implant after other causes have been investigated.
The Bottom Line
Some orthopaedic implants are deliberately temporary, while others are designed to remain for life.
K-wires and some bridging implants commonly come out once healing is complete. Most plates, screws and rods can remain indefinitely but may be removed if they become painful, prominent or interfere with nearby tissues. Hip and knee replacements are generally intended to remain permanently unless a problem develops that requires revision surgery.
The longer some fixation implants remain in place, the more bone may grow around them and the more technically difficult removal can occasionally become. However, this alone is not a reason for routine removal.
If an implant is comfortable, stable and performing its intended function, it can often simply stay where it is. Where symptoms develop, an orthopaedic surgeon can help determine whether the implant is genuinely responsible and whether removal is likely to provide enough benefit to justify another operation.
This article provides general information only and should not be considered individual medical advice. Treatment decisions should be made following a thorough assessment and discussion with your treating orthopaedic surgeon. It is not possible to determine the most appropriate procedure without considering your individual symptoms, examination findings and imaging.
