Surgical Time and Complication Risk in Conversion Total Hip Arthroplasty With Implant Removal: Finding an Optimal...

Area of Science:

• Orthopedic Surgery
• Arthroplasty
• Surgical Outcomes

Background:

• Longer surgical times in primary total hip arthroplasty (THA) correlate with increased complications.
• The impact of surgical duration on complications in conversion THA with implant removal remains under-explored.

Purpose of the Study:

• To investigate the relationship between surgical time and complication rates in conversion THA involving implant removal.
• To identify a critical surgical duration threshold associated with increased complication risk.

Main Methods:

• Retrospective analysis of 260 conversion THAs performed between 2015 and 2021.
• Utilized Area Under the Curve (AUC) to establish a complication-predictive surgery time.
• Employed logistic regression to identify predictors of prolonged surgical duration and complications.

Main Results:

• Overall complication rate was 25.8%.
• Surgical times exceeding 114 minutes significantly predicted complications (AUC: 0.700), with a 6-fold increase in likelihood.
• Predictors for longer surgical times included cephalomedullary nails (OR: 17.47) and dynamic hip screw plates (OR: 10.9) as index implants, and higher BMI (OR: 1.10).
• Higher BMI (OR: 0.93) and surgical times >114 minutes (OR: 6.37) predicted complications.

Conclusions:

• Conversion THA requiring implant removal exceeding 114 minutes is linked to higher complication and revision rates.
• Removal of cephalomedullary nails or dynamic hip screw plates are key predictors of extended surgical duration.
• Enhanced surgical planning and patient optimization are crucial for reducing surgical times and improving outcomes.