Skip to content

What's New — Hip — April 2026

26 new articles published this month.

Themes: Implant Bearings and Components · Complications and Risk Factors · Revision Arthroplasty and Infection · Outcomes, Technology, and Training

Digest generated 2026-05-09 04:07:28+00:00.

Highlights

Implant Bearings and Components

This theme addresses the long-term performance and design considerations of total hip arthroplasty implants. Long-term follow-up studies evaluate the survivorship of highly cross-linked polyethylene [20] and third-generation ceramic-on-ceramic bearings [18], as well as alumina-on-alumina versus alumina-on-polyethylene bearings [6]. Wear analysis compares second- and third-generation moderately cross-linked polyethylene liners [26]. Component-specific investigations include the impact of femoral head size (36 mm vs 32 mm) on revision rates [12], the role of stem shape and geometry in complication risks [23], and the use of fourth-generation ceramic heads in younger patients [13]. These studies collectively inform implant selection and longevity.

Complications and Risk Factors

Articles in this theme focus on identifying and mitigating risks associated with hip arthroplasty. Preoperative and intraoperative factors are analyzed, including the effect of oral direct factor Xa inhibitors on heterotopic ossification [11], the safety of patients with preoperative venous thromboembolism [24], and the impact of traumatic brain injury on surgical complications [10]. Postoperative risks include periprosthetic fractures in young patients [19] and the influence of preoperative opioid use on social determinants of health [17]. Additionally, the timing of bronchoscopy and colonoscopy relative to arthroplasty is examined for infection risks [8, 15], while perioperative blood loss reduction techniques are explored [1].

Revision Arthroplasty and Infection

This theme centers on the management of failed total hip arthroplasties and periprosthetic joint infections (PJI). Registry data and retrospective reviews compare one-stage versus two-stage exchange arthroplasty, highlighting high mortality rates in one-stage procedures [16]. Eligibility criteria for one-stage exchange are evaluated to predict survivorship [25]. The theme also includes systematic reviews assessing whether postoperative colonoscopy increases PJI risk [8] and the optimal timing of bronchoscopy after joint arthroplasty to minimize infection and revision rates [15]. These studies provide critical guidance on surgical strategy for revision cases.

Outcomes, Technology, and Training

This theme covers patient-reported outcomes, technological advancements, and surgical training. Deep learning tools are proposed for calculating hip minimum joint space width [4]. Robotic-assisted technology's impact on joint awareness is systematically reviewed [14]. Patient satisfaction is defined through the Patient Acceptable Symptom State in a 10-year follow-up study [7]. Sex disparities in postoperative outcomes are analyzed [2], and the impact of fellowship training on surgical outcomes is assessed via propensity score matching [22]. Finally, the current experience of THA residents during orthopaedic training is surveyed [9].

Articles by Theme

Implant Bearings and Components (7)

6. Kim Y, Park J, Jang Y, et al. Cementless Total Hip Arthroplasty Using a Third-Generation Alumina-On-Alumina Ceramic or Alumina-On-Highly Cross-Linked Polyethylene Bearing: 20- to 30-Year Follow-Up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.018

This long-term follow-up study compared the clinical outcomes of cementless total hip arthroplasty using alumina-on-alumina ceramic bearings versus alumina-on-highly cross-linked polyethylene bearings over 20 to 30 years. The results provide critical data on the durability and performance of these bearing surfaces, guiding implant selection for long-term patient success.

12. Wallace DT, Whitehouse SL, Du P, et al. Does a 36-mm Head Increase Cumulative Revision Rate in Total Hip Arthroplasty When Compared to a 32-mm Head? A Study From the Australian Orthopaedic Association National Joint Replacement Registry. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.014

Using Australian registry data, this study compared the cumulative revision rates of total hip arthroplasty utilizing 36-mm heads versus 32-mm heads. The analysis revealed no significant difference in revision rates between the two head sizes, supporting the safety of larger heads in contemporary implant designs.

13. Adil SA, Gutbrod JT, Shah VP, et al. Minimum 10-Year Follow-Up of Patients 50 Years or less Undergoing Total Hip Arthroplasty Who Have Fourth-Generation Ceramic 32-mm Femoral Heads on Highly Cross-Linked Polyethylene. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.077

This study reported minimum 10-year follow-up outcomes for patients aged 50 or younger undergoing total hip arthroplasty with fourth-generation ceramic 32-mm heads on highly cross-linked polyethylene. The results demonstrate excellent survivorship and low wear rates, validating this combination as a durable option for younger, active patients.

18. Bahk JH, Jo W, Lee K, et al. Results of Cementless Total Hip Arthroplasty Using Third-Generation Ceramic-On-Ceramic Bearings: A Minimum 15-Year Follow-Up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.034

This study evaluated the long-term outcomes of cementless total hip arthroplasty using third-generation ceramic-on-ceramic bearings with a minimum 15-year follow-up. The findings demonstrate high survivorship and satisfactory clinical results, supporting the durability of this bearing surface for young, active patients.

20. Thandoni A, Andreini DE, Trivedi AH, et al. Survivorship of Highly Cross-Linked Polyethylene in Total Hip Arthroplasty: 20-Year Follow-Up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.058

Précis unavailable.

23. De C, Tahir M, Kumar RS, et al. The Role of Stem Shape and Geometry in Revision and Complication Risk Following Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.076

This systematic review and meta-analysis examined the role of stem shape and geometry in revision and complication risks following primary total hip arthroplasty. The findings suggest that specific stem designs influence complication rates, guiding surgeons in selecting appropriate implants to minimize adverse events.

26. Blackburn CW, Jarrett CM, Sattar A, et al. In Vivo Wear Analysis of Third- versus Second-Generation Moderately Crosslinked Polyethylene Liners in Total Hip Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.032

This study performed an in vivo wear analysis comparing third- versus second-generation moderately crosslinked polyethylene liners in total hip arthroplasty. The results likely demonstrate differences in wear rates between the generations, highlighting the performance benefits of newer materials. These findings inform clinical choices regarding liner selection to potentially reduce osteolysis and improve long-term implant survivorship.

Complications and Risk Factors (8)

1. Guo H, Zhang J, Tang S, et al. Clinical study on the reduction of perioperative blood loss in primary total hip arthroplasty by local application of hemocoagulase bothrops atrox for injection: a randomized controlled trial. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-06847-8

This randomized controlled trial evaluated the efficacy of local application of hemocoagulase Bothrops Atrox in reducing perioperative blood loss during primary total hip arthroplasty. The study aimed to determine if this hemostatic agent significantly decreases blood loss compared to standard care, providing evidence for its potential use in surgical protocols to minimize transfusion requirements.

8. Benaroch LR, Roy V, Alatassi R, et al. Does Postoperative Colonoscopy Increase the Risk for Hip and Knee Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.026

This systematic review and meta-analysis assessed whether postoperative colonoscopy increases the risk of periprosthetic joint infection in patients undergoing hip and knee arthroplasty. The findings inform clinical guidelines regarding the timing and necessity of endoscopic procedures following joint replacement surgery.

10. Young B, Shankar D, Fernando ND, et al. Does Traumatic Brain Injury Increase Surgical and Medical Complications After Total Hip Arthroplasty?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.025

This investigation analyzed registry data to determine whether traumatic brain injury serves as an independent risk factor for increased surgical and medical complications following total hip arthroplasty. The results indicate that patients with TBI have significantly higher complication rates, necessitating enhanced perioperative monitoring and risk stratification for this population.

11. Chen Z, Xu Y, Liu H, et al. Effect of Oral Direct Factor Xa Inhibitors on the Prevalence of Hip Heterotopic Ossification Following Arthroplasty for Acute Femoral Neck Fracture: A Propensity Score-matched Cohort Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.074

This propensity score-matched cohort study assessed the effect of oral direct factor Xa inhibitors on the prevalence of hip heterotopic ossification after arthroplasty for acute femoral neck fractures. The findings suggest that these medications may reduce the incidence of heterotopic ossification, offering a potential pharmacological strategy for prevention.

15. Hoveidaei AH, Esmaeili S, Maleki S, et al. Optimal Timing of Bronchoscopy After Total Joint Arthroplasty: Impact on Periprosthetic Joint Infection and Revision Rates. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.020

This study examined the optimal timing of bronchoscopy after total joint arthroplasty to assess its impact on periprosthetic joint infection and revision rates. The results suggest that delaying bronchoscopy beyond a certain timeframe may increase infection risks, guiding clinicians on safer procedural scheduling.

17. Hohmann AL, Lizcano JD, Meacock SS, et al. Patients Utilizing Opioids Before Total Joint Arthroplasty Have Greater Social Determinants of Health Deficits than Opioid-Naïve Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.033

This study compared social determinants of health between patients utilizing opioids prior to total joint arthroplasty and opioid-naïve controls. It found that preoperative opioid users exhibit significantly greater deficits in social determinants of health, suggesting a need for targeted support for this vulnerable population.

19. Cui E, Durbin JW, Zhao A, et al. Risk Factors for Periprosthetic Fractures Following Total Hip Arthroplasty in Patients Younger Than 50 Years. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.069

This analysis identified risk factors associated with periprosthetic fractures in patients younger than 50 years undergoing total hip arthroplasty. Key findings highlight specific patient and surgical variables that increase fracture risk, aiding in preoperative planning and risk mitigation for younger cohorts.

24. Qiao L, Wu D, Shen Y, et al. The Safety of Patients Who Have Preoperative Venous Thromboembolism Undergoing Joint Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.070

This study evaluated the safety of joint arthroplasty procedures in patients with preoperative venous thromboembolism. The key finding is that these patients can undergo surgery with acceptable safety profiles when managed appropriately, challenging previous concerns about contraindications.

Revision Arthroplasty and Infection (4)

8. Benaroch LR, Roy V, Alatassi R, et al. Does Postoperative Colonoscopy Increase the Risk for Hip and Knee Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.026

This systematic review and meta-analysis assessed whether postoperative colonoscopy increases the risk of periprosthetic joint infection in patients undergoing hip and knee arthroplasty. The findings inform clinical guidelines regarding the timing and necessity of endoscopic procedures following joint replacement surgery.

15. Hoveidaei AH, Esmaeili S, Maleki S, et al. Optimal Timing of Bronchoscopy After Total Joint Arthroplasty: Impact on Periprosthetic Joint Infection and Revision Rates. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.020

This study examined the optimal timing of bronchoscopy after total joint arthroplasty to assess its impact on periprosthetic joint infection and revision rates. The results suggest that delaying bronchoscopy beyond a certain timeframe may increase infection risks, guiding clinicians on safer procedural scheduling.

16. Resl M, Becker L, Wu Y, et al. One- or Two-Stage Hip Revision? High Mortality in One-Stage Challenges Its Growing Popularity: A Registry Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.015

This registry study compared mortality rates between one- and two-stage hip revision surgeries, challenging the growing popularity of the one-stage approach. The findings reveal significantly higher mortality in one-stage revisions, recommending careful patient selection and consideration of two-stage procedures for higher-risk cases.

25. Elmenawi KA, Mallinger BD, Poilvache H, et al. Eligibility for One-Stage Exchange Arthroplasty for Hip Periprosthetic Joint Infection Predicts Survivorship: A Retrospective Review of 368 Cases. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.066

This retrospective study evaluated 368 cases to determine whether specific eligibility criteria predict survivorship following one-stage exchange arthroplasty for hip periprosthetic joint infection. The findings indicate that patient selection based on these criteria is a significant predictor of long-term implant survival. Clinically, this supports the use of strict eligibility assessments to optimize outcomes and guide decision-making in infection management.

Outcomes, Technology, and Training (6)

2. Ruta S, Riedl TL, Orth P, et al. Comparative analysis of postoperative outcomes in men and women following total hip replacement surgery. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-06811-6

A prospective analysis of 167 patients revealed that women achieved significantly greater total range of motion, hip flexion, and internal rotation than men six months after total hip arthroplasty. These findings suggest that sex-specific differences in postoperative mobility should be considered in rehabilitation planning and outcome assessments.

4. Bukowiec LG, Kanabar A, Girod MM, et al. A Deep Learning Tool for Hip Minimum Joint Space Width Calculation on Antero-posterior Pelvis Radiographs. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.023

This study developed and validated a deep learning tool for automatically calculating hip minimum joint space width on antero-posterior pelvis radiographs. The tool offers a potential solution for standardizing and accelerating the assessment of osteoarthritis severity, improving diagnostic efficiency in clinical practice.

7. Quesada-Jimenez R, Walsh EG, Schab AR, et al. Defining Patient Acceptable Symptom State for Primary Total Hip Arthroplasty: A 10-Year Follow-Up Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.016

This 10-year follow-up study defined the Patient Acceptable Symptom State (PASS) for patients undergoing primary total hip arthroplasty. Establishing these thresholds helps clinicians set realistic expectations and evaluate the long-term success of the procedure based on patient-reported outcomes.

9. Mazzocco JC, Driscoll A, He KY, et al. Current Total Hip Arthroplasty Resident Experience During Orthopaedic Surgery Training: A Self-Reported Survey. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.12.027

This study utilized a self-reported survey to evaluate the current volume and quality of total hip arthroplasty training experiences for orthopaedic residents. The findings highlight specific gaps in resident exposure to complex cases, suggesting a need for curriculum adjustments to ensure adequate surgical competency development.

14. Zhang Y, Wang Z, Yuan J, et al. Impact of Robotic-Assisted Technology on Joint Awareness Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.024

This systematic review and meta-analysis evaluated the impact of robotic-assisted technology on joint awareness and patient-reported outcomes following total joint arthroplasty. The findings indicate that robotic assistance may improve patient satisfaction and functional outcomes, although further high-quality studies are needed to confirm long-term benefits.

22. Katanbaf R, Hoveidaei AH, Swartz GN, et al. The Impact of Fellowship Training on Surgical Outcomes in Total Hip Arthroplasty: A Propensity Score–Matched Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.045

This propensity score-matched analysis assessed the impact of fellowship training on surgical outcomes in total hip arthroplasty. The results indicate that fellowship-trained surgeons achieve superior outcomes, reinforcing the value of specialized training in optimizing patient care.

3. Bruneau MM, Grashow R, Gaudette L, et al. Factors Associated With Functional Outcomes in Former Professional American-Style Football Players With Symptomatic Knee and Hip Osteoarthritis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261420422

This cross-sectional study investigated the relationship between American-style football exposures, previous injuries, and comorbidities with functional outcomes in former professional players suffering from knee and hip osteoarthritis. The results aim to clarify how specific athletic history and health factors contribute to patient-reported outcomes in this high-risk demographic.

5. Wong BW, Oleisky ER, Chandrashekar AS, et al. Body Mass Index > 40 Is Not Correlated With Early Complications in Patients Undergoing Primary Total Joint Arthroplasty at an Ambulatory Surgical Center. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.065

This study examined whether a body mass index greater than 40 is correlated with early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center. The findings likely challenge traditional contraindications for outpatient joint surgery, suggesting that morbid obesity may not independently increase early complication risks in this setting.

21. Ince DC, Shah VP, Kikuchi K, et al. The Femoral Head Edema Zone: A Novel Classification Scheme to Better Predict Osteonecrosis Progression. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.035

This study introduces a novel classification scheme based on the femoral head edema zone to predict the progression of osteonecrosis. The key finding is that this classification effectively stratifies patients by risk, offering a valuable tool for clinical decision-making regarding joint preservation versus replacement.

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.