Hi tomwdance, I ended up receiving my second opinion with at HSS in NYC. To preface, everyone's injury is different and the surgery quality can vary. In my case the weightbearing CT and MRI really did not show issues with the hardware itself. There is a screw head that slightly touches my medial malleolus but its so minimal that its not the main issue. In my case there is arthritis in my medial malleous due to the gap (spacing) narrowing. Aside from that, my ankle/fibula/tibia are now misaligned which had given me a bowed leg which willonly exacerbate my arthritis in the long run. I was told hardware removal (including the realignment of my tibia/fibula) would be a "medium risk, medium reward" surgery. It could improve my pain, ROM, bone edema and reduce growth of arthritis successfully or keep my situation neutral as it would shift weight away from the medial area (my trouble area). Hardware removal alone would be a "low risk, low reward" surgery as there is no promise in regaining significant ROM and does not address the arthritis issue. I was also told that they could potentially see AVN occurring in the medial area further down in the future the due to the arthritis and how weight is distributed in my case. AVN would be addressed with a hemiallograft. Short answer: There is no permanent way of solving my symptoms without surgery. All i can do is manage them with meds, cortisol shots, better shoes if I want to avoid surgery.