Removal of IM Tibial Nails Before TKA — Staged or Same Day?

If there's no benefit to an extra operation, it's harmful

What’s the Claim?

A large-database study quantified the risk of infection associated with patients having TKA after removal of an IM tibial nail, and it was high. For example, the increase in adjusted odds of prosthetic joint infection 1 year after nail removal was 12 (95% CI 8 to 17) if the nail was removed in a staged procedure and 7 (95% CI 5 to 11) if the nail removal and the TKA were performed on the same day. (In all cases, the authors used TKAs in patients with no prior hardware in the leg as the comparator group.)

The main findings were similar at other time points (90 days, 2 years), and the odds of other serious complications, including surgical site infection and manipulation under anesthesia, were elevated, though not to the same degree as was observed for PJI.

How’s It Stack Up?