Abstract
BACKGROUND: Metal implants are increasingly used in children for trauma and deformity correction. This review outlines the current knowledge on the types of metals used and explores reasons for removal and the potential for long-term health issues of metal implants. METHODS: The literature pertaining to these aspects was studied and summarised in this review. RESULTS: Types of metals used have evolved as well as the development of children-specific implants. Improvements in deformity correction are measurable with likely improved outcomes and reduced health costs. Indications for metal implant removal following successful treatment remain ill-defined; however, the risks of removal are known with a minimum 6% complication rate. Health costs could be reduced by around 6% by judicious decisions to leave metal in place. Implant removal should only be encouraged in the presence of infection, mechanical failure or symptoms that are truly attributable to the implant. In the domain of spinal implants, there is evidence of significant metal ion release, most notably titanium which remains elevated to many times baseline levels beyond 2 years. The detection of titanium at low levels requires special techniques. The long-term health effects on patients and/or their offspring are not well defined, although well described in animal models. CONCLUSION: The risks of metal removal are significant. Clinicians need to be aware of potential health risks in the use of metal implants and the potential for covert toxicity effects in children especially with their long life ahead. There is a need for greater awareness of metal alloy composition and implant design to minimise risks. LEVEL OF EVIDENCE: Level V.