OR Efficiency Program Improves Total Joint Arthroplasty Throughput

Published: March 03, 2026

Implementation of an operating room (OR) efficiency and analytics program can significantly improve surgical throughput and efficiency metrics for total hip and knee arthroplasty, according to research presented at the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting in New Orleans.

Radical Time Transparency is Key

“It shows you that if you seek to dial in your efficiency, you have to have radical time transparency, not just in the OR, but your turnover times,” George N. Guild III, MD, of Total Joint Specialists in Atlanta, said in his presentation. “It has changed the way I do perioperative management and it is an invaluable part of our surgery center.”

Study Details

Researchers conducted a secondary analysis of time-stamped surgical workflow data collected by a cloud-based OR efficiency and analytics program (1Team Surgical, Zimmer Biomet) for 106 total hip arthroplasties (THA) and 214 total knee arthroplasties (TKA). The data was collected during a diagnostic phase, followed by an efficiency improvement program implementation (working phase), and a subsequent follow-up phase.

Efficiency metrics assessed included total OR time, incision to implant, incision to close, wheels-in to incision, OR turnover time, and surgeon turnover time.

Findings

For TKA procedures, significant differences were observed in OR time between the diagnostic and follow-up phases. Significant differences were also found between the diagnostic and follow-up phases for incision to implant, incision to closing, wheels-in to incision, and surgeon turnover time.

For THA procedures, researchers found a non-significant trend toward shorter OR time, as well as significantly less wheels-in to incision and surgeon turnover times in the follow-up phase compared to the diagnostic phase.

Implications for Surgical Flow

“Efficiency is not new to orthopedic surgery, particularly in joint replacement,” Guild told Healio. “When you are able to have radical time transparency, you are able to make improvements in your overall surgical flow and perioperative flow, whether that is turnover, the time it takes to close the skin, maybe the amount of time it takes you to make the incision and start having implants in. When you have those time stamps, what gets measured gets improved.”

Disclosure

Guild reports having a product development agreement with Zimmer Biomet.

Source: Guild GN, et al. Paper 40. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 2-6, 2026; New Orleans.