Timing and Implant Removal
In the absence of reliable evidence, it is the opinion of the work group that implants should be removed if clinically safe and feasible due to the development of biofilm creating a barrier to successful treatment.

Rationale

Regarding the role of implant removal associated with SSI, there is a paucity of research and evidence regarding the optimal implant management. The decision to retain or remove implants based on the clinical situation balancing morbity of removal with clearance of infection. While implant retention may be necessary in many cases, it is the recommendation of this committee that implants should be removed if clinically appropriate and feasible due to the development of biofilm as a barrier to successful treatment.

Risks/Harms
There are no know harms associated with implementation of this recommendation.

Future Research
The literature is lacking in quality evidence addressing the risks of retained implants. The total joint literature is attempting to address this question regarding prosthesis, but there remains a void in the research regarding other orthopaedic implants. Future studies should address this knowledge gap and attempt to identify the optimal timing and method of implant hardware exchange.


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