Incidence of Sacroiliac Screw Implant Pain and Results of Screw Removal

Introduction: Percutaneous sacroiliac(SI) screw fixation of pelvic fractures has become commonplace. Routine removal of SI screws has been recommended by some physicians while others remove only symptomatic implants citing risks associated with this procedure. Few publications exist documenting the incidence of SI screw related hardware pain, rates of SI screw removal, the results of implant removal and the risks and complications associated with this procedure. Our objective is to document the incidence and clinical impact of symptomatic sacroiliac drew removal at a community level II trauma centers over a 12-year period.

Methods: Operative records were queried to identify 250 patients with pelvic ring injuries treated with SI screw placement at our institution. Records were analyzed to identify fracture classification, implant removal, reason for implant removal, analogue pain scales before and after implant removal and complications after implant removal.

Results: During the 12 year study period from 2006-2018, 300 posterior pelvic ring screws were placed in 250 patients. 46/250 (18.4%) patients underwent implant removal, accounting for 66 screws. 43 patients cited painful hardware as the reason for removal and 3 patients cited infection. Average time to removal was 6.7 months. Mean analog pain scales were 4.91 and 0.51 before and after removal respectively. No intra-operative or post-operative complications were encountered. All patients reported improvement in pain with screw removal

Conclusions: Postoperative pain following SI screw placement attributed to retained implant occurs in 18% of patients. Despite the previously documented proximity of neuromuscular structures, no intra-operative or postoperative complications were observed in patients who underwent screw removal. All patients reported significant relief of symptoms following implant removal. In patients experiencing pain following SI screw placement, screw removal 6 months following initial fixation is a safe and effective procedure.