Does Surgical Start Time Influence Postoperative Outcomes in Total Knee Arthroplasty? A Retrospective Hospital-Based Study

Background: Total knee arthroplasty (TKA) is a widely performed procedure for advanced knee osteoarthritis with generally predictable outcomes.While patient-related factors and surgical technique are well-recognized determinants of postoperative results, the influence of non-clinical factors such as the timing of surgery during the day remains inadequately explored.Emerging evidence suggests that circadian physiology and institutional scheduling practices may influence postoperative complications.Methods: This retrospective observational study analyzed 80 patients undergoing primary unilateral total knee arthroplasty at SCB Medical College, Cuttack (January 2023-December 2024).Patients were grouped by surgical start time into early morning, midday, and late-day categories.Demographic data, operative duration, hospital stay, and in-hospital complications were assessed using one-way ANOVA and chi-square tests, with p