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

Sophia Moody; Alan David Lam; Nihir Parikh; Matthew Sherman; Chad Krueger

doi:10.5435/JAAOS-D-24-00266

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

J Am Acad Orthop Surg. 2024 Nov 26. doi: 10.5435/JAAOS-D-24-00266. Online ahead of print.

Authors

Sophia Moody¹, Alan David Lam, Nihir Parikh, Matthew Sherman, Chad Krueger

Affiliation

¹ From the University of Rochester Medical Center, Rochester, NY (Moody), Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Lam and Parikh), Kansas City University of Osteopathic Medicine, Kansas City, MO (Lam), Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Sherman), and Orthopeadic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Krueger).

PMID: 39626194
DOI: 10.5435/JAAOS-D-24-00266

Abstract

Background: Although longer surgical times in primary total hip arthroplasty (THA) are associated with higher complication rates, this has yet to be explored in conversion THA. The purpose of this study is to investigate the relationship between surgical time and complications in the setting of conversion THA with implant removal. We aim to establish a length of surgery after which the risk of complications increases.

Methods: This was a retrospective study conducted at a single institution. A total of 260 conversion THAs performed between 2015 and 2021 were included. An area under the curve (AUC) was constructed to determine a surgery time that increased the likelihood of complications. Logistic regressions were run to determine predictors for longer surgical times and complications.

Results: The overall complication rate of conversion THA involving implant removal was 25.8% (67 patients). Surgical times greater than 114 minutes were found to be a predictor of complications (AUC: 0.700, 95% Confidence Interval [CI]: 0.630 to 0.771), with complications 6 times as likely in these cases (9.57% vs. 34.9%, P < 0.001). Regression analysis revealed that index implants of cephalomedullary nails (P < 0.001, odds ratio [OR]: 17.47) and dynamic hip screw plates (P < 0.001, OR: 10.9) were notable predictors of surgical times greater than 114 minutes along with higher body mass index (P = 0.005, OR: 1.10). Higher body mass index and surgical times greater than 114 minutes were also found to be predictors of complications (P = 0.035, OR: 0.93; P < 0.001, 6.37).

Conclusion: Conversion THA cases involving implant removal that are longer than 114 minutes are associated with higher complication rates and revision surgeries. Conversion THA requiring implant removal of cephalomedullary nails or dynamic hip screw plates were predictors for longer surgical times. Improved surgical planning and perioperative patient optimization may be viable options to limit surgical times. This information can be used to counsel patients on the risk of complications and the possibility of a staged procedure if appropriate.