How Long Does Surgery for a Hip Replacement Take?

A standard, first-time hip replacement takes roughly an hour and a half of actual operating time. A large analysis of over 157,000 procedures found a median operative time of 87 minutes, and that figure has stayed remarkably stable over the past decade or more.¹ That number, though, is just the middle of a wide range. Depending on the surgical approach, the surgeon’s experience, your body type, the technology used, and whether a trainee is involved, the clock can land anywhere from under an hour to well over two hours.

What Counts as “Surgery Time”

When people ask how long hip replacement surgery takes, they usually mean the time they’ll be unconscious or numb on the table. But hospitals track several distinct time segments. A study examining operating room efficiency broke the perioperative timeline into five phases: anesthesia preparation (from entering the operating room to being ready for surgery), surgical preparation (from anesthesia ready to the first incision), the procedure itself (incision to closure), the anesthesia finish (closure to leaving the room), and turnover time before the next patient.² The “total case time” that hospitals record runs from entering the room to leaving it, which adds roughly 20 to 40 minutes of non-surgical preparation and wrap-up around the core procedure.

One retrospective study illustrated this gap clearly. Normal-weight patients undergoing hip replacement had a mean total operating room time of about 139 minutes, yet the actual operation time within that window averaged 86 minutes.³ The remaining time covered anesthesia induction, patient positioning, sterile draping, and post-procedure care before transfer. If your surgeon tells you the operation will take about an hour and a half, your family should expect you to be away from your room for closer to two and a half hours.

How the Surgical Approach Changes the Timeline

Surgeons reach the hip joint through different routes, and the path they choose has a meaningful effect on how long the procedure takes. The two most common approaches are the posterior approach, where the incision is made behind the hip, and the direct anterior approach, where the surgeon works through the front of the thigh. A systematic review and meta-analysis of randomized trials found the posterior approach averaged about 65 minutes of operating time, while the anterior approach averaged about 80 minutes, a difference of roughly 16 minutes.⁴ A separate multicentre randomized trial found an even larger gap, with the anterior approach averaging about 70 minutes compared to 46 minutes for the posterior approach.⁵

The anterior approach takes longer partly because the anatomy is tighter and the surgical exposure is more demanding, particularly in muscular or heavier patients. Surgeons who favor it argue that the trade-off is worth it for recovery: because no muscles are cut (they’re moved aside rather than detached), many patients get back on their feet faster. But from a pure operating-time standpoint, the posterior approach is consistently quicker.

Does Robotic Surgery Take Longer?

Robotic-assisted hip replacement has been gaining traction, and one of the first questions patients ask is whether the robot adds time. The evidence here is mixed and depends a lot on how experienced the surgical team is with the technology.

A network meta-analysis of randomized controlled trials found that manual hip replacement had a pooled mean surgical time of about 87 minutes, compared with roughly 111 minutes for robotic-assisted procedures and 96 minutes for computer-navigated ones.⁶ A broader systematic review and meta-analysis similarly found that robotic assistance added about 8 minutes on average, though the range across studies was enormous.⁷

But those pooled averages include early-adoption studies where teams were still learning the system. A more granular single-institution study that looked at surgeons already comfortable with the robot found no meaningful difference at all: 76 minutes for robotic-assisted and 77 minutes for manual procedures.⁸ Interestingly, the robotic arm actually reamed the hip socket faster than a human hand did. The extra steps that the robot requires, like placing tracking pins and registering the patient’s anatomy in the system, ate up roughly the same amount of time as manual reaming, resulting in a wash. In short, robotic surgery may add 10 to 25 minutes when a team is still building fluency, but that gap shrinks and can disappear entirely at experienced centers.

Body Weight and Operating Time

Higher body weight consistently makes hip replacement take longer. A meta-analysis of prospective studies found that obese patients had an increase in operating time of about 11 minutes compared to non-obese patients.⁹ But that average understates the effect at the higher end of the weight spectrum. A retrospective study that grouped patients by weight category found that normal-weight patients averaged about 86 minutes of operation time, obese patients were slightly higher, and morbidly obese patients averaged about 103 minutes, an increase of roughly 17 minutes.³

The extra time is not just the surgery itself. The same study found that anesthesia induction also took longer in heavier patients: about 21 minutes for normal-weight patients versus 28 minutes for morbidly obese patients. Positioning a larger patient safely, establishing reliable intravenous access, and getting adequate imaging all add up. Total operating room time for morbidly obese patients in that study reached roughly 168 minutes compared to 139 minutes for normal-weight patients. If you’re carrying significant extra weight and are headed for a hip replacement, expect the overall time commitment on the day to be noticeably longer.

The Surgeon’s Experience and Teaching Hospitals

Few factors affect operating time as dramatically as how many hip replacements a surgeon has done. A systematic review covering more than 630,000 procedures found clear consensus that experience shortens the clock. One tracked series showed a single surgeon’s average operative time falling from about 133 minutes during the first 100 cases to about 106 minutes by the third 100.¹⁰ Another series documented a similarly steep drop even within a surgeon’s first 50 cases.

Teaching hospitals introduce a separate wrinkle. When a surgical resident participates in the operation, the procedure takes longer. One institutional study found that resident involvement added about 12 minutes on average to hip fracture surgery, bringing the mean from roughly 79 to 91 minutes.¹¹ A study of minimally invasive hip replacements found a similar pattern, with trainee operations averaging about 9 minutes longer than those performed by senior surgeons alone.¹² Separate data from the same systematic review found increases of 12 to 15 minutes when residents were present.¹⁰

This does not mean teaching hospitals produce worse outcomes. The evidence on complication rates generally shows no difference, and the attending surgeon is scrubbed in and supervising throughout. But if you’re having surgery at an academic medical center, it is reasonable to expect the procedure to take slightly longer than advertised averages.

Anesthesia Type Matters More Than You’d Think

The choice between general anesthesia (where you’re fully asleep) and spinal anesthesia (a numbing injection in the lower back that leaves you awake or lightly sedated) affects how long you spend in the operating room. A large propensity-adjusted analysis found that general anesthesia was associated with an increase of about 12 minutes in operative time and an additional 5 minutes in post-procedure room time compared to spinal anesthesia.¹³ A separate comparison of 606 patients similarly found that spinal anesthesia resulted in about a 12% reduction in operative time.¹⁴

That said, a more recent institutional study found that the actual surgical time (incision to closure) was nearly identical between the two methods, at about 87 minutes for spinal and 90 minutes for general anesthesia. The difference showed up in the non-operative time: getting the patient ready and transferring them out of the room was about 4 minutes shorter overall with spinal anesthesia.¹⁵ General anesthesia requires intubation, ventilator setup, and a slightly longer wake-up period, all of which tack on minutes at the beginning and end. Spinal anesthesia, by contrast, is quicker to administer and the patient can be transferred more efficiently. For most patients, the anesthesia choice probably makes a 5-to-15-minute difference in total room time, not the surgery itself.

When Both Hips Need Replacing

Some patients need both hips replaced, and the decision about whether to do them simultaneously (in a single anesthesia session) or staged (weeks or months apart) has real implications for time on the table. An early study found that simultaneous bilateral replacement roughly doubled the operating time and blood loss compared to a single hip.¹⁶ A more recent study of high-volume surgeons found cumulative operative times of about 61 minutes for simultaneous bilateral procedures and 58 minutes per hip for staged ones, indicating that in experienced hands, each individual side takes about the same amount of time either way.¹⁷

An analysis of over 2,000 simultaneous bilateral cases found that surgical time per side was not different from a single-hip replacement.¹⁸ In practical terms, if a single hip takes about 90 minutes, doing both in one session takes roughly three hours of operating time when you factor in repositioning between sides. The advantage is one anesthesia event and one recovery period instead of two; the downside is a longer single session, higher blood loss, and a more demanding early recovery.

Why a Longer Surgery Carries Higher Risk

Beyond patient convenience, the length of a hip replacement matters clinically. A large study of nearly 90,000 hip replacements found a linear relationship between operative time and complication rates: once the procedure exceeded about 75 to 80 minutes, the rates of readmission, reoperation, surgical site infection, and need for blood transfusion all climbed in step with each additional minute.¹⁹

The risks escalate at specific thresholds. A study of registry data found that operations lasting 90 to 119 minutes raised the risk of minor complications by about 20% compared to shorter procedures. Procedures stretching to two or three hours raised major complication risk by about 40%, and surgeries exceeding three hours more than doubled it.²⁰ A recent systematic review and meta-analysis confirmed that operations running two hours or longer were associated with a substantially higher risk of infection after hip replacement.²¹

None of this means a longer operation is necessarily a bad sign. Complex anatomy, revision surgery (replacing an old implant), and unusual bone loss all legitimately require more time. The data do, however, reinforce something intuitive: all else being equal, a surgeon who can work efficiently without cutting corners is giving you a measurably safer operation.

Outpatient Versus Inpatient Settings

Where the surgery takes place can also influence time. A study comparing operating times across settings found that outpatient orthopedic procedures averaged about 88 minutes, while the same procedures performed in an inpatient hospital setting averaged about 135 minutes.²² Part of this gap reflects patient selection: candidates for outpatient hip replacement tend to be younger, healthier, and leaner, meaning fewer intraoperative challenges. But ambulatory surgery centers also tend to run tighter schedules with more streamlined workflows, which trims non-surgical time.

Outpatient hip replacement has become increasingly common for patients who meet the criteria. The surgical time itself is not fundamentally different, but the overall time you spend in the facility is shorter because same-day discharge is the goal. You won’t have the multi-day hospital stay, though you will still spend time in the recovery room.

Recovery Room Time After the Procedure

Once the actual surgery is finished and you’re wheeled out of the operating room, you enter the post-anesthesia recovery phase. A study at an ambulatory surgical center found that the average time patients spent in the recovery room after total joint replacement was about three and a half hours.²³ During this time, the care team monitors your blood pressure, manages pain, checks that sensation is returning if you had a spinal block, and confirms you can meet basic discharge milestones like keeping fluids down and having stable vital signs.

Older patients and men tended to stay longer in the recovery room in that study. Your individual timeline will depend on how you respond to anesthesia, how well your pain is controlled, and whether you’re heading home the same day or being admitted. For planning purposes, if you add about 90 minutes of operating time to about three and a half hours of recovery, you’re looking at roughly five hours from the time you enter the OR to the point where you might be moved to a hospital room or begin the discharge process. Add in the pre-surgical check-in, IV placement, and pre-operative waiting, and a full day at the facility is realistic.

Revision Surgery and Complex Cases

Everything discussed so far applies to primary hip replacement, meaning the first time an artificial joint goes in. Revision surgery, where a worn-out or failed implant is removed and a new one is placed, is a different beast entirely. Revision cases routinely take two to three hours or more of surgical time. The surgeon may encounter scar tissue from the original operation, bone loss around the old implant, or infection that must be addressed before new hardware can be placed. Specialized implants with longer stems or augments to fill bone defects add to the complexity.

Fractures around an existing implant (periprosthetic fractures) are similarly time-consuming, sometimes requiring cables, plates, or even bone grafting in addition to the component exchange. If your surgeon mentions that your case is a revision rather than a primary replacement, it’s worth expecting a significantly longer day.

Putting Your Own Timeline Together

Given all these variables, you can roughly estimate where your surgery might fall. A straightforward primary hip replacement by an experienced surgeon using the posterior approach, performed under spinal anesthesia on a patient of normal weight, might take 60 to 75 minutes of cutting time. Switch to the anterior approach, add a robotic arm at a center still early in its learning curve, and operate on someone with a high body mass index in a teaching hospital, and two hours or more becomes realistic. Most patients land somewhere in the middle, between 75 and 110 minutes of actual surgical time, wrapped inside a total room occupancy of about two to two and a half hours.

If you’re trying to set expectations for family members waiting, tell them three hours from the moment you’re taken back, recognizing it could be faster. And build in the recovery room time: someone should have a book, a charger, and patience for roughly half a day at the facility before you’re alert and ready for visitors or discharge.