JOA - 2026-06-09 - Journal Article
How Do Operating Room Timings Differ Between Anterior and Posterior Approaches for Total Hip Arthroplasty.
Ruff G, Di Pauli von Treuheim T, Sarfraz A, Metko K, Rozell JC, Schwarzkopf R, Aggarwal VK
Topics
Key Takeaway
Anterior approach THA reduces total OR time by 10.6 minutes (156.7 vs 167.4 min) compared to posterior approach, driven by shorter setup (-2.0 min), closure (-7.5 min), and take-down (-3.6 min) times, though implantation time is 3.3 minutes longer.
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Summary
This study compared perioperative OR timing components between anterior and posterior approach primary THA at a single academic center from 2019–2025, using multivariable regression controlling for ASA status, BMI, cementation, robotic/navigation use, and surgeon learning curve (first 50 cases excluded). AA was associated with shorter total OR time (156.7 vs 167.4 min), shorter setup, closure, and take-down times, but longer implantation time (+3.3 min). Cemented fixation disproportionately increased AA operative time (+28.9 min) compared to PA (+14.4 min, P<0.001).
Key Limitation
Single-center data limits generalizability, as OR timing differences are highly dependent on institutional workflow, staff familiarity, and implant system availability for each approach.
Original Abstract
BACKGROUND
Total hip arthroplasty (THA) is commonly performed using either an anterior- or posterior-based approach (AA or PA), with similar long-term outcomes. However, operative timings, including time for patient positioning, device implantation, wound closure, and total operating room (OR) time, may differ between these approaches. This study assessed differences in various OR timings between AA and PA for primary THA.
METHODS
A retrospective review was performed of all patients who underwent primary, unilateral, elective THA at our large urban academic medical center between January 1, 2019, and January 31, 2025. Patient demographics and operative parameters were determined from clinical and operative records. Surgeons who began practicing during the study period had their first 50 cases excluded. Perioperative timings were compared between approaches. Multivariable regression analyses controlled for age, American Society of Anesthesiologists status, body mass index, cementation, robotic use, navigation assistance use, discharge disposition, sex, smoking status, and year of surgery. There were 8,120 procedures included (4,670 PA and 3,450 AA).
RESULTS
The AA had shorter total OR time (156.7 versus 167.4 minutes, P < 0.001). Regression analysis found AA was associated with longer implantation time (+3.3 minutes, P < 0.001), but shorter set-up time (-2.0 minutes, P < 0.001), closure time (-7.5 minutes, P < 0.001), overall operative time (-4.2 minutes, P < 0.001), and take-down time (-3.6 minutes, P < 0.001). Cement fixation had an increased effect on AA operative times compared to PA (+28.9 versus +14.4 minutes; P < 0.001).
CONCLUSIONS
Anterior approach THA procedures displayed faster set-up, closure, take-down, and OR times compared to PA. Controlling for covariates, AA reduces total OR time by nearly 10 minutes, although operative time with AA is more significantly impacted by cementation. Further studies investigating the cost analysis of AA versus PA are needed to contextualize these findings regarding timing.