I’m currently scheduled to have my 2 titanium screws removed from my my incision, just below my knee. It isn’t the bioabsorbable screw, as that is not wise to remove, being deep into the bone. The surface area with the 2 screws is sensitive, but is only minor pain- probably a 2 on a 10 point scale. With my insurance deductible met, I’m tempted to have the screws removed, but I don’t want unnecessary risk.
The purpose of the screws being there is to hold your graft (replacement ACL) in place. After healing for a year, the screws are no longer necessary, as the graft has healed in its place. [see a company that makes the screws]
Below is what I have learned so far about having your ACL surgery screws removed (hardware). These responses are from an experienced arthroscopic surgeon who is the staff doctor for a professional basketball team.
- Do you recommend me having screws in my knee (near incision) removed?
Answer: only remove them if you have pain in that area. Don’t remove them for other reasons, such as thinking someday in the future they may become a problem, or that you might get arthritis (not true).
- What are all the risks of having the screws removed?
Answer: So, the surgery itself is not risky, but the risks are the same as for any surgery, including infection (that may lead to death), and fasciitis (damage to nerves, vessels, and tissue).
- What are all the risks of leaving the screws in (not having surgery)? (arthritis, pain, etc?)
Answer: None. There is no known risk of leaving in the hardware. In years past, it was more common to remove hardware, but is done less and less in recent years as techniques have improved. There is no risk of arthritis, despite what some people believe. Arthritis only exists near a joint, and the screws are not at the knee joint, but below at the place of incision.
- What % of the surgeries (for removing screws) have complications?
Answer: None the surgeon is aware of.
- Of all the ACL surgeries you have performed, what % have had their screws removed?
About 1% to 5% have their screws removed due to pain it causes- from doing about 100 ACL surgeries per year for many years.
- Of all ACL surgery patients who have had their screws removed, what % noticed improvement (less pain) and were satisfied?
Answer: Most all who had pain in that area had reduced or no more pain in that region.
- How long is the procedure to remove screws?
Answer: Short, only about 15-20 minutes, but additional time for preparation, such as anesthesia, prepping the leg (shaving hair, cleaning, sterilizing, etc), and recovery. The surgery is a relatively simple procedure, as its near the surface. The only thing covering the heads of the screws are skin and a little fatty tissue, including nerves and vessels. That part is cut and the titanium screws (and washers) are removed using a regular hand-held screw driver (not a drill). Then the incision is sewn back together and its done. There is no endoscopy or any other procedure needed.
- Does the procedure require anesthesia and will the patient be asleep?
Yes. The initial unscrewing of the screw from the bone would be painful without anesthesia. You need to be completely asleep for it. It’s also possible to have partial anesthesia so you’re not 100% asleep.
- Will the screws being removed make the fixation any weaker?
No. After a year goes by, the graft has fused into the bone where it should not be weaker without the screws.
- What is the typical recovery time after the screws are removed?
You can walk the same day, but crutches are recommended for the first day or two. You will be sore in that area. No pain medication is needed post surgery. After 1 week, you should be able to resume normal athletic activities.
- Is there any advantage (timeliness) in having screws removed sooner vs later? (such as years into the future?)
No, there is no advantage at all. Your body will respond in the same way, whether 1 year after surgery or 10, or 20 years. If there’s no pain causing you to need to take out the screws, don’t take them out. Simply wait and see if it becomes a problem and is painful and if so, then take them out down the road, since there’s no disadvantage in waiting.
- What are the exact billing codes used for this? (codes you may give your insurance company to determine whether your plan covers it or not)
20680 – hardware removal
plus billing codes for the surgeon’s fee, the anesthesiologist, any assistants
An additional questions that would be nice to ask:
What % of ACL patients have a problem with their screws unscrewing on their own?
So, has anyone had their hardware removed (screws, etc) after having ACL surgery and what was your experience (do you recommend it)?