Factors predicting enhanced early clinical outcomes following elective implant removal

Abstract

Objective : Patient-related pain is commonly observed after surgically treated fractures. Studies have examined pain and function improvements as well as complications after elective implant removal. Outcomes vary based on factors like implant location and patient characteristics. However, most patients with initial pain and dysfunction show improvements in standardized scoring systems. Previous studies relied on subjective pain scores and patient satisfaction, but newer tools like PROMIS offer better assessment. Certain questions remain unanswered, such as outcomes in terms of MCID. The study aims to predict patient-reported outcomes after elective implant removal by analyzing preoperative factors. To determine preoperative factors predictive of improvement in pain and function after elective implant removal. We hypothesized that patients undergoing orthopaedic implant removal to relieve pain would have significant improvements in both pain and function. Methods : Retrospective cohort study. Level I Trauma Center. 36 were enrolled after consenting for orthopaedic implant removal to address residual pain. 30 were available for 3-month follow-up. Results : Preoperative and postoperative outcome measures including Patient Reported Outcomes Measurement Information System (PROMIS) scores were compared. Preoperative scores, surgeon prediction of pain improvement were analyzed as predictors of outcomes. Median PROMIS physical function and pain interference scores and visual analogue scale significantly improved by 6, 8, and 2 points, respectively. Worse preinjury scores predicted improvement in respective postoperative outcomes. Surgeon prediction of improvement was associated with improved PROMIS pain interference, patient subjective assessment of pain improvement, and subjective percent of pain remaining at 3 months. Conclusions : Although the primary indication for implant removal in this population was pain relief, many patients also had a clinically relevant improvement in physical function. In addition, patients who start with worse global indices of pain and function are more likely to improve after implant removal. This suggests that implant-related pain directly contributes to global dysfunction.