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Should you take out the metal after surgery - Japanese vs. western approach

So you've been unlucky enough to injury yourself and have surgery. Hopefully you've undergone a full rehabilitation program and have regained your functional capacity. However, if your surgery has involved internal fixation (metal screws/plates) then a discussion may be had about whether or not these should remain in the body.





In my 20 years of working with post-surgical patients in Japan, this has been one interesting point of contrast between the western and Japanese approaches. In the west, the metal implants are often left in, whereas in Japan, they are often removed at a certain time point depending on the type of procedure and demographics of the client.


Some of the reasons for removing the hardware may be:

  1. Cultural and medial practices. In Japan it is believed that the body functions better without foreign particles

  2. Avoiding long-term complications. Metal implants can cause long-term irritation, discomfort and inflammation, particularly if the metal is located directly under the skin. There is also a very small risk of late-onset infections

  3. Mobility and comfort. Removal can help facilitate improved range of motion and less perceived stiffness.

  4. Advances in surgery. As surgery techniques improve, the trauma and risk involved with implant removal has greatly improved.


Some reasons to leave the the hardware in

  1. Avoiding the trauma and potential (although very low) risk of unnecessary surgery.

  2. Modern implants are designed for permanent use

  3. Culturally - more focus on function than being natural

  4. Cost. Further surgery requires additional funding which is costly to the individual and/or the public/private healthcare systems. This is likely a big factor in the United States.


The evidence regarding optimal outcomes is sparse and somewhat conflicting. Some studies show improved outcomes and lower re-fracture risk, others show the opposite. The consensus of surgeons worldwide is also mixed.


From my 20 years of working in Japan, my anecdotal experience is that people often feel much better after having the metal removed, particularly if they are experiencing ongoing stiffness or can “feel” the plate directly under the skin. While I have been known to be critical of many aspects of orthopaedic medicine in this country, I do believe that this practice is of potential benefit to the client, and should be considered in appropriate cases.

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