Journal of Pediatric Orthopaedics - 2026-07-01 - Journal Article; Comparative Study
Fracture Risk Following Hardware Removal in Children With Arthrogryposis.
Hyer LC, Shull ER, Potash AM, Schneider B, Waters E, Wang J, Westberry DE
Topics
Key Takeaway
Postoperative fracture incidence following hardware removal after lower extremity osteotomy in arthrogryposis is 9.4% per patient (6.8% per procedure), significantly higher than a matched cerebral palsy cohort where zero fractures occurred.
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Summary
This study quantified fracture and infection rates following hardware removal after lower extremity osteotomy in arthrogryposis patients aged 0-20 years and compared outcomes to a 1:1 age-, location-, and implant-matched CP cohort. Fractures occurred in 9.4% of arthrogryposis patients (6.8% per procedure) versus 0% in CP controls; infection rates were equivalent between groups (6.8% per procedure, P=1.0). The fracture disparity implicates arthrogryposis-specific bone quality or biomechanical factors beyond those shared with CP.
Key Limitation
The study does not report bone mineral density, cortical thickness, or time-to-hardware removal, making it impossible to identify which patients are at highest fracture risk or whether a safe interval for removal exists.
Original Abstract
BACKGROUND
Children with arthrogryposis often undergo lower extremity long bone osteotomy for improved biomechanical alignment with subsequent hardware removal. The incidence of fracture and infection is unknown in this population. Therefore, the aim of this study was to identify the incidence of these complications following hardware removal and compare them to a matched cohort of patients with cerebral palsy.
METHODS
Patients with arthrogryposis aged 0 to 20 years who underwent lower extremity osteotomy with subsequent hardware removal were included. All hardware removal events were recorded and evaluated for postoperative fracture or infection. For comparative analysis, each patient with arthrogryposis was matched 1:1 with a patient with cerebral palsy based on age, osteotomy location, and implant type at the time of the first hardware removal event.
RESULTS
Fifty-three patients with arthrogryposis were included with a total of 73 hardware removal procedures. Postoperative fractures occurred in 9.4% of patients, and infections in 5.3%. When calculated per hardware removal event, the incidence of both fracture and infection was 6.8%. Thirty-seven patients were successfully matched with a cerebral palsy counterpart. There were no differences in infection rates between groups ( P =1.0); however, the arthrogryposis cohort sustained 3 fractures postremoval, while no fractures were observed in the cerebral palsy cohort.
CONCLUSION
Children with arthrogryposis have a relatively high risk of fracture following hardware removal after lower extremity osteotomy. Caution is advised when removing metallic implants in this population.
LEVEL OF EVIDENCE
Level III-retrospective comparative study.