Understanding What Happens if a Rod Is Not Removed from the Body?

September 30, 2025 •

5 min read

While estimates suggest that unintentionally retained surgical items occur in a small percentage of abdominal operations, when it comes to orthopedic implants like rods, it is often a common and safe practice to leave them in permanently, but what happens if a rod is not removed from the body?. This decision depends on several factors, including the patient's condition and whether the hardware is causing issues.

Quick Summary

Surgical rods are often left in the body permanently and cause no issues, but in some cases, complications like pain, infection, or hardware failure necessitate removal. The decision to remove depends on weighing the risks of a second surgery against the potential benefits of symptom relief. Many factors influence this choice, including hardware prominence, patient age, and the extent of bone healing.

Key Points

Hardware Can Remain Safely: Modern surgical rods and other fixation devices are often made of inert materials like titanium and can be left in the body indefinitely without causing problems.
Pain is the Main Driver for Removal: The most common reason for a surgeon to recommend hardware removal is if the implant becomes prominent or causes persistent pain and irritation to surrounding tissues.
Risk of Infection Exists: While not always a reason for removal, there is a risk of infection developing around an implant, even years later, which typically requires surgical intervention to clear.
Failure is Possible: Over time, surgical hardware can loosen or break, especially if the bone healing is delayed or incomplete, which often necessitates revision surgery.
Removal is a Second Surgery: The decision to remove hardware requires a careful balance, as it is a second surgical procedure that carries its own set of risks, including nerve damage and re-fracture.
Metal Allergies Are Rare but Possible: An uncommon immune reaction or allergy to the implant's metals can occur, causing symptoms like pain, swelling, and skin irritation.
Consult Your Surgeon: Any new or persistent symptoms around the implant site should be evaluated by an orthopedic specialist to determine if hardware removal is necessary.

The Common Practice: Leaving Orthopedic Hardware In Place

For many patients, surgical rods, screws, and plates—collectively known as orthopedic hardware—can remain safely in the body for a lifetime. The primary purpose of this hardware is to stabilize a fracture while the bone heals. In many cases, once the bone has fully recovered and integrated around the implant, the hardware no longer serves a functional purpose, but can still be left in place without issue. This is especially common with intramedullary rods used to fix fractures in long bones like the femur, where removal involves significant risks.

For most individuals, the decision to leave the hardware is based on a favorable risk-benefit analysis. A second surgery to remove the implant carries its own risks, including infection, damage to nerves, blood loss, and a longer recovery period. If the hardware is not causing any symptoms, the risks associated with removal often outweigh any potential benefit.

Risks and Potential Complications

While it is common for hardware to remain in the body without problems, there are several reasons why complications might arise, necessitating a future surgery. The following issues can emerge at any point, from months to many years after the initial procedure.

Pain and Prominent Hardware

One of the most frequent reasons for removing orthopedic hardware is pain or discomfort. The implant may become prominent, especially in areas with thin soft tissue coverage, such as the ankle, foot, wrist, and collarbone. This can cause irritation when a person wears shoes, puts pressure on the area, or engages in certain activities. Tenderness in the area where the hardware is located is a common symptom.

Infection

While rare, an infection can develop around a surgical implant, even years after the initial surgery. This is because bacteria can adhere to the surface of the metal, making it difficult for the body's immune system to fight them off. Symptoms of infection can include increased pain, swelling, warmth, redness, and wound drainage. A low-grade infection may also cause implant loosening or chronic pain.

Hardware Loosening or Failure

Over time, orthopedic hardware can loosen, bend, or break. Implants have a finite lifespan, and if the fracture doesn't heal correctly, the hardware may be subject to loads that cause it to fail. This can lead to increased pain, implant migration, or the need for revision surgery to replace the broken device. Signs of loosening may be visible on an X-ray as a 'halo' around screws.

Metal Hypersensitivity or Allergic Reaction

Although uncommon, some individuals may have a sensitivity or allergic reaction to the metals in their implants, such as nickel, cobalt, or chromium. This can manifest as persistent pain, swelling, a rash, or eczema around the implant site. These reactions can contribute to implant loosening and failure. Patients with known metal allergies should inform their surgeon before surgery, as special titanium-based materials are often used.

Impact on Adjacent Joints

For certain implants, such as those used in spinal fusion surgery, the presence of the rod can alter the natural movement of the spine. This can place additional stress on the vertebrae above and below the fused segment, leading to accelerated wear and tear and a condition known as adjacent segment disease. This can result in new or worsening back pain over time.

The Decision-Making Process for Removal

Deciding whether to remove a surgical rod is a complex process. It involves a careful evaluation by both the patient and the orthopedic surgeon, weighing the potential risks and benefits. There is no standard guideline for routine removal in adults, with decisions made on a case-by-case basis.

Indications for Removal

Symptomatic Pain: If the hardware is causing persistent pain, irritation, or functional limitations.
Infection: If an infection has occurred, removal is often necessary to fully eradicate the bacteria.
Hardware Failure: If the implant has loosened or broken.
Incomplete Healing: If the bone did not heal properly (nonunion) and further intervention with different hardware or a bone graft is needed.
Patient Preference: Some patients, due to psychological discomfort or the desire to resume high-impact activities, may opt for removal.

Weighing the Risks and Benefits


Aspect	Leaving the Hardware In Place	Removing the Hardware
Benefits	Avoids risks and costs of a second surgery. Allows for continued support in some cases. No interruption to daily life if asymptomatic.	Can eliminate pain and discomfort caused by prominent or failing hardware. Resolves infections associated with implants. May improve function or reduce psychological discomfort.
Risks	Potential for long-term complications like pain, infection, or failure. May cause metal allergies. Can interfere with future imaging or treatments.	Risks associated with any surgery, including nerve damage, infection, bleeding, and blood clots. Potential for re-fracture or incomplete pain relief.
Outcome	Often uneventful, allowing for a normal, active life. Requires monitoring for complications.	Symptoms may resolve, but there is no guarantee. Recovery time is needed, and the implant site will heal over time.

The Recovery After Hardware Removal

Recovery from hardware removal surgery is generally less intensive than the initial procedure. However, the exact recovery time and restrictions depend on the implant's location and the complexity of the removal. Your surgeon will provide specific post-operative instructions, which may include limited weight-bearing for a period to allow the bone to fully strengthen again. While scar tissue from the original surgery can increase the risk of minor nerve damage during removal, most patients recover without incident.

Conclusion

In conclusion, whether a surgical rod is removed or left in the body is a significant medical decision. For most patients, modern surgical hardware is safe to be left in place permanently, especially when no symptoms are present. The primary triggers for removal are complications such as persistent pain, infection, or mechanical failure of the implant. Each case is unique, and a thorough evaluation of the patient's symptoms, overall health, and the specific risks of a revision surgery is critical. For individuals experiencing issues with their implants, consulting with an orthopedic specialist is the best course of action to determine the most appropriate treatment plan.

For more information on the topic, a detailed article published by the American Academy of Orthopaedic Surgeons (AAOS) provides excellent resources on internal fixation for fractures and potential complications.

Frequently Asked Questions

Yes, it is very common and often the standard procedure for surgical rods and other orthopedic hardware to be left in the body permanently if they are not causing any problems. The decision to remove it is only made if complications arise.

The most common first signs are persistent pain, discomfort, or irritation at the implant site. The hardware may also become noticeable or prominent under the skin, especially in areas with little soft tissue coverage.

If a rod or screw breaks, it typically requires revision surgery to remove the broken hardware and replace it. A broken or loose implant can cause significant pain, nerve damage, and potentially threaten the stability of the healed bone.

Yes, although it is rare, some people can have a hypersensitivity or allergy to the metals used in implants, such as nickel, chromium, or cobalt. This can cause symptoms like pain, swelling, and a rash around the implant area.

Risks of hardware removal surgery include the general risks of any operation, such as anesthesia complications, infection, and nerve or blood vessel damage. The procedure can also cause temporary weakening of the bone or a risk of re-fracture.

Yes, large metal implants like rods, plates, and joint replacements often trigger airport metal detectors. It's advisable to inform security personnel and be prepared to show a medical ID card or provide an explanation.

Doctors will conduct a thorough physical examination, ask about your symptoms, and review imaging studies like X-rays or CT scans. If other potential causes for the pain are ruled out, and the pain is localized to the implant site, it may be attributed to the hardware.