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How Do Operating Room Timings Differ Between Anterior and Posterior Approaches for Total Hip Arthroplasty?
Garrett Ruff1, Theodor Di Pauli von Treuheim1, Anzar Sarfraz1
1Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
The Journal of Arthroplasty
|June 9, 2026
Summary
Anterior approach total hip arthroplasty (THA) reduces operating room time compared to posterior approach THA. Anterior approach hip surgery is faster overall, though cement fixation impacts operative time more significantly.
Area of Science:
- Orthopedic Surgery
- Surgical Outcomes
- Arthroplasty
Background:
- Total hip arthroplasty (THA) is commonly performed via anterior (AA) or posterior (PA) approaches.
- While long-term outcomes are similar, operative timings may differ between AA and PA.
Purpose of the Study:
- To compare operative timings between anterior approach (AA) and posterior approach (PA) for primary total hip arthroplasty (THA).
- To identify differences in patient positioning, device implantation, wound closure, and total operating room (OR) time.
Main Methods:
- Retrospective review of 8,120 primary THA procedures (3,450 AA, 4,670 PA) from 2019-2025.
- Multivariable regression analyses controlled for patient and surgical variables.
- Comparison of perioperative timings between AA and PA.
Main Results:
- Anterior approach (AA) THA had shorter total OR time (156.7 vs. 167.4 minutes, P < 0.001).
- AA was associated with longer implantation time but shorter set-up, closure, and take-down times.
- Cement fixation increased operative times more significantly for AA compared to PA (+28.9 vs. +14.4 minutes, P < 0.001).
Conclusions:
- Anterior approach THA procedures demonstrate faster set-up, closure, take-down, and overall OR times than posterior approach.
- AA reduces total OR time by approximately 10 minutes, adjusted for covariates.
- Further cost-effectiveness studies are warranted to contextualize timing differences between AA and PA.