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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.
Background:
Total hip arthroplasty (THA) is commonly performed using either an anterior-based 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.