Factors affecting operative time in primary total hip arthroplasty: A retrospective single hospital cohort study of 7674 cases

BACKGROUND: Total hip arthroplasty (THA) is one of the most common orthopedic procedures in developed countries, and the high volume of surgery and the socioeconomic burden of failures demand continuous optimization. Operative time has been identified as a significant independent factor influencing the clinical outcome of THA. OBJECTIVE: The aim of this study was to analyze factors influencing the operative time for THA in a large, single-center cohort. METHODS: A consecutive series of 7,674 cases undergoing primary THA was identified, and after multiple imputation of missing values, univariable and multivariable linear regression analyses were performed. RESULTS: In the univariable analysis, all factors showed significant influences on operative time, while multivariable regression analysis revealed that sex, a diagnosis of hip dysplasia and small femoral component size did not reach significance. Younger age, an underlying diagnosis other than osteoarthritis or hip dysplasia, a large stem size, usage of a conventional stem rather than a short stem, a larger cup size and a cemented fixation technique, however, remained significantly influential in terms of a longer operative time. CONCLUSIONS: This study identified risk factors for longer operative time that in turn is associated with a higher rate of periprosthetic joint infection and impaired clinical outcome. Our findings could help to refine scheduling of total hip arthroplasty procedures in times of increasing cost and efficiency pressure.