HIP International

Each surgical approach for primary THA has unique advantages. The direct lateral approach (DLA) offers increased visualisation of the gluteus medius and minimus tendons and, consequently, has been suggested to facilitate management of intraoperatively identified abductor tears. However, there remains a paucity of data exploring the frequency of abductor tears in patients undergoing primary THA via DLA. The purpose of this prospective study was to: (1) report the incidence of abductor tears in the DLA patients; and (2) identify risk factors for abductor tears in patients undergoing primary THA.

All patients undergoing primary THA for osteoarthritis via the DLA by 3 high-volume, fellowship-trained arthroplasty surgeons from September 2023 to March 2024 were enrolled. Data on patient demographics and preoperative functional outcome scores were collected. The location, size, and tissue quality for patients with an abductor tear intraoperatively was also recorded. Receiver operating characters (ROC) curve analysis was utilised to determine abductor tear risk factors.

Of the 346 patients included in the analysis, 63 (18.2%) had an abductor tear. There was no difference in BMI, laterality, and preoperative functional outcome scores between groups. However, patients with an abductor tear were more likely to be older (70.1 ± 7.9 versus 65.0 ± 9.5 years, p < 0.001), Women (68.3% vs. 31.7%, p = 0.027), and have a higher age-adjusted Charlson comorbidity index score (4.0 ± 1.7 vs. 3.3 ± 1.9, p = 0.002). Using ROC curve analysis, patients 68 years of age or older were 2.99 times more likely to have a tear identified. Of all tears, 87.3% of tears were at the anterior aspect of the greater trochanter with a mean size of 26.6 ± 12.1 by 12.9 ± 11.5 mm.

In the present study, the incidence of abductor tears in patients undergoing primary THA via the DLA was 18.2%. Future studies are needed to compare the implications of abductor tears encountered in primary THA.

Postoperative rehabilitation following total hip arthroplasty is important for optimising functional recovery and pain relief. This study compares a mobile application providing functional recovery exercises and pain management education with in-person physical therapy in patients undergoing total hip arthroplasty.

A retrospective study was conducted with 2 cohorts (n = 94) matched using propensity score matching. The App group (n = 47) used a mobile app for postoperative follow-up, while the control group (n = 47) received conventional follow-up. Functional outcomes (Harris Hip Score [HHS], Merle D'Aubigné [MDP], WOMAC) and pain intensity (visual analogue scale [VAS]) were assessed preoperatively, at one month, and 3 months post-intervention.

Both groups showed significant improvements in all measurements compared to preoperative values. However, the App group showed significant improvements compared to the control group in the following outcome: HHS at 3 months (P = 0.02), improved MDP mobility (P = 0.02) and walking ability (P < 0.0001), and lower VAS pain scores at one month (P = 0.004) and 3 months (P = 0.01).

The mobile app program with recovery exercises and pain management is more effective than in-person physiotherapy in improving function and reducing pain after total hip arthroplasty.

The study was registered with the US National Institutes of Health (NIH) under the number: NCT06606158. https://clinicaltrials.gov/study/NCT06606158

56 patients with severe acetabular bone defects with or without pelvic discontinuity were included. In the TCA group 31 patients and 25 in the 3D group with a minimum follow-up of 2 years were included. The main indication for revision surgery with acetabular bone defect was aseptic loosening in both groups.

The mean follow-up was 57.21 ± 28.81 months. Implant survival rates were 90.32% in the TCA group and 100% in the 3D (P = 0.24). Functional outcomes improved in both groups based on the Merle D'Aubigné & Postel score, with greater improvement in the 3D group (9.24 ± 3.23 vs. 6.55 ± 2.59 points, P = 0.001). Pain levels improved equally in both groups. Surgical time was shorter in the 3D group (108 ± 34.5 vs. 129 ± 43.4 minutes, P = 0.047).There were no significant differences in reoperation rate, transfusion need, hospital stay, or mortality.

Tantalum metal cups and augments and custom-made 3D-printed trabecular titanium implants demonstrated an excellent survival rate in the management of severe acetabular bone defects. The group of patients operated on with custom 3D-printed implants had better postoperative functional outcomes and a shorter surgical time.

Short-stem total hip arthroplasty (THA) aims to preserve proximal femoral bone stock and promote physiological load transfer compared to conventional cementless stems. This design is particularly relevant for younger, active patients, in whom long-term implant survival and bone preservation are critical.

To systematically review and meta-analyse the functional and radiological outcomes of short-stem THA in young patients.

A systematic search of Medline, Embase, PubMed, and the Cochrane Library was conducted to May 2025 following PRISMA guidelines. Eligible studies included patients with mean age <55 years and ⩾4.5 years mean follow-up. Primary outcome was Harris Hip Score (HHS) or modified Harris Hip score (mHHS); secondary outcomes were complications, survivorship, and radiological findings.

32 studies involving 4082 hips (mean age 46.7 years, mean follow-up 8.6 years) were included. Mean HHS improved from 45.3 to 93.8. Complications were infrequent, including intraoperative fracture (1.6%), dislocation (0.6%), and infection (0.4%). Radiological changes, including osteolysis (1.3%), heterotopic ossification (1.9%), and stem subsidence ⩾2 mm (0.7%), were uncommon. Stem survivorship free from aseptic loosening was 99.7%. The overall revision rate was 1.6%. Subgroup analyses indicated better outcomes and lower revision rates with posterolateral approaches and ceramic-on-ceramic bearings.

Short-stem total hip arthroplasty in patients younger than 55 years appears to be associated with excellent mid- to long-term functional outcomes, low complication rates, and high implant survivorship. While these findings suggest that short stems are a safe and durable option for young, active patients, substantial heterogeneity across studies and the limited randomised evidence warrant cautious interpretation. These findings are hypothesis-generating and warrant confirmation in adequately powered prospective studies.

No: CRD420251046310

Hip resurfacing arthroplasty (HRA) is a femoral bone-preserving alternative to total hip arthroplasty (THA) for younger, active patients. However, complications such as fractures, loosening, and metal wear can require conversion to THA. In some cases, revision of both the acetabular and femoral components is required.

We conducted a retrospective review of 15 patients who underwent conversion of HRA to THA at a single, academic tertiary care centre between January 2011 and April 2024. Demographic data, surgical details, implant characteristics, and indications for conversion were collected. Postoperative outcomes including complications, reoperations, and revisions were investigated. Revision-free survival was estimated using Kaplan-Meier analysis.

The mean age was 53.2 years and mean time to conversion was 6.7 years. Indications for conversion included adverse reaction to metal debris (ARMD; n = 6), mechanical loosening (n = 3), component positioning and impingement (n = 3), periprosthetic fracture (n = 1), osteolysis/wear (n = 1), and prosthetic joint infection (PJI; n = 1). Common reasons for acetabular cup revision included ARMD (n = 6), loosening (n = 4), and positioning (n = 3). Dual-mobility (DM) constructs were used in 11 cases (73.3%). There were no dislocations. There was 1 90-day readmission due to persistent wound drainage which underwent debridement, antibiotics, and implant retention (DAIR) 14 days post-conversion. The average follow-up duration after the conversion procedure was 6.1 years. Kaplan-Meier analysis demonstrated 93% revision-free survival at one-year, which remained stable through 13 years.

In this study of 15 both-component HRA conversions, we observed 93% revision-free survivorship at mid-term follow-up. While the small cohort size limits definitive conclusions, our findings suggest that revision of the acetabulum during conversion, particularly with dual-mobility constructs, may be an effective strategy to mitigate instability and manage metal-on-metal failure in appropriate patients. Further research with larger cohorts is warranted to confirm our findings.

Hydroxyapatite (HA) is an osteo-inductive material commonly added to the surface of components to enhance bone implant fixation; however, clinical studies have demonstrated inferior performance of HA coated acetabular cups in total hip arthroplasty. This study aims to compare the performance of a contemporary acetabular cup either with or without electrochemically deposited HA.

50 patients were randomised to receive an acetabular cup either with plasma porous spray (PPS) or an electrochemically deposited HA coating during primary THA for osteoarthritis. Acetabular bone remodelling behaviour adjacent to the cup was assessed using dual energy x-ray absorptiometry (DEXA) scans by a blinded observer at 6 weeks, 3, 6 and 12 months. Patient-reported outcomes and satisfaction were recorded at the same time points.

No significant differences in periacetabular BMD changes over time between the 2 different cup types was observed. Both cohorts showed significant improvement in PROMs over 12 months postoperatively with no significant difference in satisfaction. There were no revisions or component loosening in either group up to 12 months.

This study found similar clinical performance and acetabular BMD changes for both porous plasma and electrochemically deposited HA coated cups in primary THA up to 12 months postoperatively.

This study applied the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to evaluate the statistical fragility of outcomes reported in RCTs evaluating TXA against a saline control in total hip arthroplasty (THA).

PubMed, Embase, and MEDLINE were searched for RCTs on TXA in THA compared to a saline control. FI and rFI were calculated for dichotomous outcomes, representing the number of outcome reversals required to alter significance.

32 studies were included. Across 69 total outcomes, the median FI was 3.0 (IQR 2.0–6.0) with an associated median FQ of 0.031 (IQR 0.020–0.053), suggesting that 3 outcome event reversals would alter significance for 50% of all outcomes. 18 outcomes were statistically significant, with a median FI of 3.0 (IQR 1.0–5.0) and a median FQ of 0.026 (IQR 0.017–0.036). 51 outcomes were non-significant, with a median rFI of 4.0 (IQR 2.5–7.0) and a median FQ of 0.032 (IQR 0.020–0.066). Results designated as primary outcomes were more fragile (median FQ = 0.025, n = 20) than non-primary outcomes (median FQ = 0.032, n = 49).

The efficacy of TXA use during THA from RCTs is statistically fragile, particularly among significant outcomes and those related to blood or platelet transfusion rates. We recommend combined reporting of p-values with FI and FQ metrics to help interpret clinical findings in RCT involving TXA use during THA.

Robotic-assisted total hip arthroplasty (RA-THA) has been shown to improve the accuracy of component positioning, but the learning curve for efficient operative performance remains debated.

We retrospectively reviewed 579 consecutive RA-THA procedures performed between June 2021 and June 2023 at a single centre using the MAKO robotic system. Surgeon 1 performed cases via the direct anterior approach (DAA), and Surgeon 2 via the posterolateral approach (PL). A historical cohort of conventional manual THA served as a control group. Operative time was the primary outcome. Learning curves were assessed using cumulative summation (CUSUM) analysis, with proficiency defined as the inflection point at which operative times stabilised. Demographic variables were compared among learning-phase, proficiency-phase, and conventional cohorts.

A total of 434 DAA and 145 PL RA-THA cases were analysed. For the DAA cohort, proficiency was achieved after 73 cases; mean operative time decreased from 97.9 ± 17.5 minutes during the learning phase to 79.7 ± 16.6 minutes during the proficiency phase (p < 0.001). For the PL cohort, proficiency was achieved after 41 cases; operative time decreased from 89.7 ± 21.6 minutes to 72.8 ± 14.5 minutes (p < 0.001). Compared with conventional THA, proficiency-phase RA-THA operative times were slightly shorter for the DAA (−3 minutes, p = 0.045, small effect size) and comparable for the PL approach (p = 0.632). No significant differences in baseline demographics were observed among groups.

Robotic-assisted THA is associated with substantial learning curves for operative efficiency, with longer thresholds observed for the DAA compared with the PL approach. Although RA-THA has been associated with early improvements in implant positioning accuracy, operative efficiency appears to improve more gradually with experience. Institutions adopting RA-THA should anticipate approach-specific learning curves, implement structured training pathways, and prepare surgical teams for an initial adaptation period.

Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly utilised for metabolic optimisation in surgical patients. Their effect on postoperative patient-reported outcomes (PROMs) and satisfaction following primary total hip arthroplasty (THA) has not been well established. This study aimed to describe the association between GLP-1 prescription history and: (1) 1-year postoperative PROMs; (2) 1-year patient satisfaction; and (3) complication rates.

This is a retrospective study of 12,749 patients who underwent primary unliteral THA at a tertiary medical centre from January 2016 to December 2022. GLP-1 agonist use was defined as a documented prescription history of a GLP-1 agonist within 1-year prior to surgery (n = 145). Multivariable logistic regression was used to evaluate GLP-1 use and 1-year PROMs [Hip disability and Osteoarthritis Outcome Score (HOOS) Pain, Physical function Shortform (PS), and Joint Replacement (JR)]. Clinical improvements were determined by the patient acceptable symptom state (PASS) and minimal clinically importance difference (MCID) thresholds. We also used multivariable logistic regression to assess the independent association between GLP-1 use and postoperative complications.

No significant difference was observed between patients with a prescription history for a GLP-1 agonist and failure to achieve PASS, MCID, or satisfaction at 1-year (odds ratio [OR] 0.99, 95% confidence interval [CI], 0.51–1.9; p = 0.98). However, there was reduced odds of 90-day readmission in patients with a prescription history for a GLP-1 agonist (OR = 0.47, p = 0.043) and an increased rate of 90-day medical complications (9.66% vs. 6.01%, p = 0.001). No significant differences were found for length-of-stay, 90-day emergency visits, or 2-year implant complication rates.

This observational study found that patients with GLP-1 agonist prescription history experienced an increased rate of medical complications but a reduced rate of 90-day hospital readmission. Conversely, the negative findings of the study should be interpreted cautiously as the small, exposed cohort limits statistical power.

Prevalence of periprosthetic fractures (PPFs) is continuously increasing. This study aimed to: (1) report on outcomes following revision THA (r-THA) for PPFs; (2) identify factors associated with mortality; and (3) report on the performance of modular tapered fluted stems (MFTs) as the revision stem-type of choice.

This is a retrospective, consecutive case series of all femoral PPFs treated with r-THA at an academic, tertiary-referral centre between 2008 and 2023. Patients managed solely with open reduction internal fixation (ORIF) were excluded. Demographic and clinical data were collected from electronic medical records. Radiographic analysis was used to assess canal filling ratio, fracture union, stem subsidence, stability and survivorship. Primary outcomes measured included reoperations and mortality as well as stem survivorship free of re-revision at latest follow-up.

96 patients/hips satisfied criteria (mean age: 76 years; 62% female). Most (83%) underwent rTHA for Vancouver B2 fractures. Dislocation post rTHA was detected in 10% of patients. 29% of patients required reoperation. Mortality rates at 30 days and 1 year were 4% and 10%, respectively. Patient- (higher Charlson Comorbidity Index [CCI] 1.70 ± 1.49 vs. 0.80 ± 1.57, p = 0.02) and surgical- (dislocation post-rTHA – 30%, [OR 4.8] p = 0.03) factors were associated with 1-year mortality. MFTs (n = 83) demonstrated a 2-year and 5-year all-cause re-revision survivorships of 95.2% (95% CI, 87.9–99.7) and 94.0% (95% CI, 79.0–97.0), respectively.

Postoperative mortality following rTHA for PPF is associated with patient and surgical factors. While we did not establish a causal relationship, as dislocation is associated with increased mortality, surgeons should strongly consider the use of dual-mobility or constrained liner bearings at revision when conversion of acetabular bearing surface is possible. MFTs are a reliable option when used during rTHA for an indication of PPF.

To analyse the clinical, radiological, and functional outcomes of robotic-arm assisted total hip arthroplasty (RA-THA) with a mean follow-up of 2 years at Hospital Clínico San Carlos, Madrid.

A prospective descriptive study was conducted including patients who underwent RA-THA using the Mako system (Stryker) between October 2021 and March 2024. All procedures were performed by 4 dedicated hip surgeons, excluding each surgeon’s learning curve. Demographic, clinical, functional, and radiological parameters were analysed. Mean follow-up exceeded 24 months.

A total of 226 patients were included (52% male, 48% female), with a mean age of 64.9 ± 12.9 years. Mean follow-up was 27.1 (range 12–36) months.

Preoperative diagnoses were primary hip osteoarthritis in 88.5%, developmental dysplasia in 5.8%, avascular necrosis in 3.1%, post-traumatic osteoarthritis in 1.8%, and subcapital fracture nonunion in 0.4%.

Mean operative time was 87.9 ± 23.4 minutes. Intraoperative complications included 11 technical events related to marker loss (4.86%), 6 greater trochanter fractures (2.6%), and 2 calcar fractures (0.8%).

Mean acetabular component positioning was 43.1 ± 3.4° of inclination and 14.2 ± 3.8° of anteversion. Native femoral offset was preserved, with a mean difference of 1.8 ± 4.5 mm. Planned limb-length discrepancy accuracy was 90% within ±5 mm. Modified Harris Hip Score (mHHS) improved from a preoperative mean of 51.7 to 87.9 at 1 year (p < 0.001).

During follow-up, 5 neurological complications were recorded, 5 postoperative greater trochanter fractures, and 5 infections (2.2%), all successfully treated. 1 traumatic dislocation (0.4%) occurred without revision surgery.

Robotic-arm assisted THA achieves high accuracy and precision in implant positioning and limb-length restoration, with a low dislocation rate. Operative time, complication rates, and short- to mid-term functional outcomes fall within the ranges previously reported in the literature for conventional techniques. Long-term studies are required to determine the impact of robotic assistance on implant survivorship.

As the number of total hip arthroscopies performed rises, further research is needed on the impact hip arthroscopy (HA) may have on total hip arthroplasty (THA). This study aimed to compare clinical and patient-reported outcomes of THA in patients with and without a history of HA.

We retrospectively reviewed 167 patients who underwent unilateral, primary THA following ipsilateral HA from 2012 to 2024 (HA, n = 167). Patients were propensity matched 3:1 to THA patients without history of ipsilateral HA (NHA, n = 448) based on age, sex, race, smoking status, American Society of Anesthesiologists score, body mass index, and Charlson Comorbidity Index. Perioperative data, rates of complications and reoperation/revisions, Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR), and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected. Logistic regression was used to assess if the likelihood of reoperation was related to prior HA and surgical approach.

Patients with history of HA had longer mean follow-up duration (4.2 vs. 2.2 years, p < 0.001), lengths of stay (p = 0.013) and shorter operative times (p < 0.001). HA patients had higher dislocation and post-THA arthroscopy rates (p = 0.006; p = 0.020). Time to return to operation room was longer in the HA group compared to NHA cohort (334.1 vs. 104.4 days, p = 0.019). HA was associated with increased rates of reoperation due to dislocation (adjusted odds ratio 7.89, 95% CI, 1.68–36.9, p = 0.009). Surgical approach for THA was not associated with postoperative dislocation rate. Patient-reported outcomes were not different among the 2 cohorts.

In our study, THA patients with history of HA experienced increased rates of dislocation and return to operation room. These findings highlight a need for increased clinical awareness. These findings may inform intraoperative and postoperative modifications to increase prosthetic hip stability. Additionally, this knowledge can have implications for insurance billing and payments, as these cases are coded as primary THA but may present with more complexity or worse outcomes.

Use of the direct anterior approach (DAA) in total hip arthroplasty (THA) has increased, with suggested benefits of faster recovery and less pain. However, consensus regarding the optimal approach is lacking. This study compared post-operative pain, functional recovery, and opioid use between DAA and posterior approach (PA) THA.

We retrospectively reviewed 3618 primary THAs (DAA, n = 1809; PA, n = 1809) performed by fellowship-trained surgeons between 2019–2024. Cohorts were matched by age, sex, BMI, and CCI. Postoperative visual analogue scale (VAS) pain scores, Activity Measure for Post-Acute Care (AM-PAC) scores, and opioid consumption (morphine milligram equivalents, MME) were compared using independent t-tests.

Mean VAS pain scores were similar within the first 24 hours postoperatively. From 18 to 24 hours postoperatively, the PA cohort showed significantly higher VAS scores (4.32 [DAA] vs. 4.68 [PA], p = 0.006), although these differences are not clinically significant. Mean AM-PAC scores were significantly higher in the DAA cohort within 6 hours (22.3 [DAA] vs. 21.4 [PA], p < 0.001) and from 18 to 24 hours post-surgery (21.8 [DAA] vs. 20.1 [PA], p < 0.001), but these small differences do not reflect clinical significance. MME comparison showed a trend towards decreased opioid consumption within the DAA cohort, but the clinical relevance of these differences is unknown.

Pain, function, and opioid use were largely comparable between DAA and PA, with minor statistical differences unlikely to be clinically meaningful.

In Dorr type A femurs (DTAF), the flared anatomy renders proximal femoral filling (PFF) with a standard-length stem (STA) challenging, although this is essential to ensure favourable outcomes. This study compared clinical and radiographic outcomes between standard and shortened versions of a same cementless stem in DTAF. Our hypothesis was that there would be no differences in clinical outcomes, PFF or osseointegration between the 2 stems.

We reviewed 87 THA files performed in DTAF from 2013 to 2015 for STA and from 2015 to 2019 for shortened-length stems (SHO). At minimum 2-year follow-up, 8 patients were unavailable for evaluation, leaving 79 THA: 34 STA and 45 SHO. Femoral morphology was assessed preoperatively with the canal-calcar ratio (CCR) and canal bone ratio (CBR). Outcomes included: Oxford Hip Score (OHS) and PMA, proximal canal fill ratio (CFR)(A) and (B), stem subsidence and alignment, distal cortical hypertrophy, and Engh score.

There were no significant differences in clinical outcomes, PFF and osseointegration between the 2 groups. Greater migration was observed in STA. Distal cortical hypertrophy was seen exclusively in SHO and was significantly associated with a worse OHS. CCR was significantly correlated with proximal CFR. Aligned stems were significantly associated with higher CFR(B).

There were no differences in clinical or radiographic outcomes of STA and SHO in DTAF. Increasing CFR enhanced stem alignment, while femoral morphology significantly influenced PFF. SHO migrated less, but exhibited distal cortical hypertrophy, which may indicate early stress-shielding and challenge the stem’s “short” designation.

In comparison to the traditional posterolateral approach (PLA) for total hip arthroplasty (THA), the direct superior approach (DSA) is an alternative, less invasive posterior approach. Its minimally-invasiveness could make the DSA suitable for implementation in fast-track surgery. This study evaluated outcomes of a fast-track protocol including the DSA and compared patient-reported outcome measures (PROMs) to national data of the PLA.

A single-surgeon series of 50 primary THA patients who underwent fast-track DSA surgery with short-acting articaine spinal anaesthesia were retrospectively reviewed. Length of hospital stay (LOS), postoperative in-hospital pain (0–10 NRS rest/activity), patient satisfaction (1–10 NRS), adverse events and PROMs until 1 year post-surgery were collected. Data of 858 matched THAs of the PLA from the Dutch Arthroplasty Register was used for a comparison of PROMs.

Median LOS was 2 (range 1–7) days. Overall mean in-hospital pain scores were 1.6 ± 0.9 (rest) and 2.2 ± 0.9 (activity). Patient satisfaction score (only available in n = 10, 20%) was 8.6 ± 1.3 on average. A dislocation occurred in 1 patient. Compared to baseline, all PROMs scores improved after 3 and 12 months of follow-up. PROMs scores of the fast-track DSA group were better than the national PLA averages at each time point, including the baseline assessment. However, between-group differences were small and not significant.

Fast-track THA surgery using the DSA and short-acting articaine spinal anaesthesia demonstrated a short LOS, low in-hospital pain scores and few serious complications. Postoperative PROMs scores were good, but not clinically superior to nationwide PLA outcomes.

This study utilises Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data to compare survivorship of total hip arthroplasty (THA) with cemented and cementless acetabular fixation. To minimise confounders, only cases using cemented polished tapered stems with metal heads and highly cross-linked polyethylene (XLPE) liners for primary diagnosis of osteoarthritis were included.

AOANJRR data were analysed from 01 September 1999 to 31 December 2022. The study population included all primary conventional THA performed for osteoarthritis using a cemented polished tapered stem with a bearing surface of metal head articulating with XLPE. These procedures were divided into two groups: procedures with either cemented or cementless acetabular fixation. The analyses were undertaken using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazards models. Results were stratified by age and 3 surgeon volume groups: ⩽10, 10–25, and >25 procedures per surgeon per year.

There were 96,574 THAs performed for osteoarthritis using a cemented polished tapered stem included. Of these, 5,926 used cemented and 90,648 used cementless acetabular fixation. There was no difference in the rate of revision when cemented acetabular were compared to cementless acetabular procedures (HR 1.01; 95% CI, 0.86–1.18; p = 0.916). The most common reasons for revision surgery were similar for both fixation methods and included periprosthetic fracture, dislocation/instability and infection. There were no differences in the rate of revision when procedures were stratified by age or surgeon volume.

For patients undergoing a primary THA for osteoarthritis there is no difference in the rate of revision between cemented or cementless acetabular fixation when utilising a cemented polished stem with modern bearing surfaces. The authors advocate the use of cemented acetabular fixation as a viable alternative and emphasise the need for continued teaching of the skills required to ensure the technique is not lost for future generations of orthopaedic surgeons.

While comparisons exist between manual (MA-THA), computer-assisted (CA-THA), and robotic-assisted total hip arthroplasty (RA-THA), they have not considered surgeon/hospital learning curves. Therefore, we compared surgical outcomes between MA-THA/CA-THA/RA-THA among hospitals with ⩾1 year of RA-THA experience.

In this retrospective study (2016–2023, Premier Healthcare Database), we included adults undergoing elective MA-THA/CA-THA/RA-THA for non-traumatic/non-neoplastic diagnoses. Our primary outcome was any mechanical complication within 1-year follow-up; secondary outcomes included any infection within 1 year. We conducted pairwise mixed-effects logistic regression and reported odds ratios (OR) and 95% confidence intervals (CI).

Among 75,966 MA-THAs, 6,207 CA-THAs and 17,497 RA-THAs, odds of any mechanical complication within 1-year were: CA-THA versus MA-THA (OR 0.63, CI 0.52–0.75; p < 0.001), RA-THA versus MA-THA (OR 0.81, CI 0.73–0.90; p < 0.001) and RA-THA versus CA-THA (OR 1.44, CI 1.14–1.82; p = 0.003). Differences between RA-THA and CA-THA were primarily due to higher odds of mechanical loosening (OR 2.40, CI 1.19–4.85; p = 0.015) with RA-THA. Dislocation was less likely with RA-THA compared to MA-THA (OR 0.57, CI 0.44–0.72; p < 0.001). CA-THA (OR 0.46 CI 0.34–0.63; p < 0.001) and RA-THA (OR 0.83 CI 0.71–0.97; p = 0.022) were associated with significantly lower odds of infection within 1 year compared to MA-THA. RA-THA was associated with higher odds of infection within 1 year compared to CA-THA (OR 2.11 CI 1.43–3.09; p < 0.001).

With up to 1-year follow-up, CA-THA was associated with the lowest odds for mechanical complications, primarily due to mechanical loosening and infection.

Acetabular sourcil morphology has been linked to hip instability and pain. We investigated whether MRI findings at age 5 years predict sourcil morphology at skeletal maturity in developmental dysplasia of the hip (DDH).

We retrospectively reviewed 71 surgically treated hips that were followed to skeletal maturity. On final anteroposterior radiographs, the sourcil was classified as type A (downsloping), type B (horizontal), or type C (upsloping). Coronal MRI at 5 years was used to measure bony, cartilaginous, and labral acetabular indices and centre-edge angles, and the labral junction obliquity angle (LJOA). Predictors of type C morphology were assessed using multivariable logistic regression and ROC analyses.

At 5 years, radiographic acetabular index and centre-edge angle did not differ among sourcil types. In contrast, hips that developed type C morphology showed smaller cartilaginous and labral centre-edge angles and a smaller LJOA on MRI. In multivariable analysis, a smaller cartilaginous centre-edge angle and a smaller LJOA independently predicted type C morphology. Optimal cutoff values were 23° for the cartilaginous centre-edge angle (AUC 0.902) and 89° for the labral junction obliquity angle (AUC 0.964).

MRI at age 5 years may help identify DDH hips at risk of developing an upsloping sourcil at skeletal maturity.

2-stage revision arthroplasty remains the current gold standard for treatment of chronic periprosthetic joint infection (PJI) of the hip and knee in the United States. Rates of infection eradication have been shown to vary from 60% to 91%. The purpose of this study was to determine the true fate the of 2-stage exchange protocol for PJI using an updated classification system for PJI treatment outcomes as well as the effect of systemic host and local extremity grades on outcomes.

A retrospective review of a PJI registry was performed from a single institution from January 2010 through December 2021. All patients having undergone a planned 2-stage exchange after primary or revision total knee arthroplasty (TKA) and total hip arthroplasty (THA) for chronic PJI defined by Musculoskeletal Infection Society criteria were included. Perioperative variables and tiered outcome at final follow up were collected.

In total, 589 cases (561 patients) met final inclusion criteria and were included in the analysis. 394 cases (66.9%) retained their implants at median follow-up of 3.7 years (IQR 1.8, 7.7). 311 cases (52.8%) underwent successful two-stage revision with prosthesis retention without ongoing use of suppressive antibiotics, while another 83 cases (14.1%) retained their prosthesis with use of suppressive antibiotics. 152 cases (25.8%) underwent subsequent septic or aseptic revision, amputation, arthrodesis, spacer retention while 40 (6.8%) died during the study period.

At 3.7 years after surgery, 66.9% of 2-stage exchanges for PJI resulted in retained prosthesis with or without use of suppressive antibiotics. The remaining 33.1% of this population underwent additional surgery (25.8%), or were deceased (6.8%).

Effective preoperative planning is essential for reducing pain, fatigue, and joint damage following total hip arthroplasty (THA). This study investigates the effects of key geometric parameters – neck-shaft angle (NSA), anteversion angle (AVA), and hip offset (HO) – on muscle mechanics and joint reaction forces during normal walking gait using musculoskeletal simulation.

A MATLAB-based HO tool combined with a femoral torsion tool was used to generate 45 OpenSim models with systematic variations in NSA, AVA, and HO. All models were evaluated using identical gait kinematics and ground reaction forces to isolate the biomechanical influence of geometric changes.

Increases in femoral neck length and HO substantially affect muscle lever arms and joint reaction forces, with peak hip and knee joint loading and associated muscle mechanics increasing by up to approximately 2.5-fold compared to the reference model. Changes in NSA, AVA, and HO significantly altered muscle moment arms, muscle activations, and muscle forces, particularly in hip abductors and flexors. Simultaneous variation of all 3 parameters produced markedly larger effects than isolated changes.

This study highlights the importance of considering prosthesis geometry and implantation parameters during THA planning and biomechanical modelling to optimise gait mechanics and reduce postoperative joint loading.