Complication rates following open surgical removal of osteosynthesis material from the pelvis and acetabulum: a retrospective case series of 154 removals

Background and purpose: While complication rates for primary pelvic and acetabular fracture surgeries are well documented, limited data exists on complications following osteosynthesis implant removals. We aimed to evaluate the complication rates of pelvic implant removals with respect to the surgical approach, type of implant, and indication for removal.Methods: This retrospective, consecutive case series included all patients undergoing pelvic implant removal between January 2013 and December 2023 using Kocher-Langenbeck, modified Stoppa (AIP), or ilioinguinal approaches for the removal. Isolated minimally invasive, percutaneous implant removals were excluded.Results: 154 implant removals in 141 patients were analyzed. Overall complication rate was 34% (n = 53). Most common complications were intraoperative bleeding requiring transfusion (n = 17; 11%), postoperative anemia requiring transfusion (n = 12; 7.8%), and vascular injuries (n = 9; 5.8%). The ilioinguinal approach showed a higher complication rate (19/37; 51%) than the Kocher-Langenbeck (21/68; 31%) or the Stoppa/AIP approach (13/49; 27%). Removal of implants from the anterior pelvic ring and acetabulum (22/45; 49%) also had a higher complication risk than from the posterior pelvic ring and acetabulum (20/67; 30%) or of symphyseal plates (11/42; 26%). Removal due to infection also showed a particularly high complication rate (25/57; 44%) compared with aseptic indications, e.g., interfering material or removal for THA.Conclusion: Pelvic implant removals, especially from the anterior pelvic ring or acetabulum, using the ilioinguinal approach, and in case of infection, are associated with a particularly high complication risk. These findings can support clinical decision-making and informing patients on the potential risks of hardware removals.