Surgical Time and Complication Risk in Conversion Total Hip Arthroplasty With Implant Removal: Finding an Optimal Surgical Duration
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".