Elective Hardware Removal After Long-Term Osseous Integration: A Case Report

Late orthopedic hardware removal following fracture union is most commonly indicated in the setting of post-traumatic osteoarthritis (PTOA), whereas elective removal in asymptomatic patients remains controversial. We present the case of a 53-year-old male with a history of tibial plateau open reduction and internal fixation (ORIF) over a decade prior, who developed severe PTOA requiring total knee arthroplasty (TKA). PTOA is a known long-term complication of tibial plateau fractures, occurring in up to 44% of cases and approximately 5% of patients. Preoperative imaging demonstrated significant osseous overgrowth surrounding the hardware, and operative planning was further complicated by the lack of prior medical records. Intraoperative findings displayed extensive osseous integration. Following successful removal of periarticular screws, the proximal plate necessitated controlled mechanical fatigue and transection to permit safe extraction while preserving cortical stability. Partial hardware removal facilitated preparation for future arthroplasty while minimizing the risk of neurovascular injury or iatrogenic fracture. This case highlights the technical challenges of delayed hardware removal and supports consideration of earlier elective removal in select patients as a way to mitigate the risks associated with complex late salvage procedures.