What's New — Hip — September 2026¶
127 new articles published this month.
Themes: Hip Arthroscopy Outcomes & Techniques · Periacetabular Osteotomy & Dysplasia · Primary THA Techniques & Implants · Revision THA & Periprosthetic Complications · Hip Fracture & Geriatric Trauma · Arthroplasty Systems & Perioperative Care
Digest generated 2026-10-04 16:26:17+00:00.
Highlights¶
Hip Arthroscopy Outcomes & Techniques¶
A large body of work this month addresses hip arthroscopy for femoroacetabular impingement syndrome (FAIS), covering capsular management, labral treatment, and patient selection. Interportal and T-type capsulotomy yield comparable survivorship and clinically significant outcomes [6], while periportal capsulotomy shows promise in borderline/dysplastic women [15] and identifies young men with lower Tönnis grade and alpha angle as likely responders [37]. Labral repair and reconstruction produce comparable short- to mid-term results [26], and healed labrum on postoperative MRI predicts superior outcome achievement [13]. Bilateral procedures, staged or simultaneous, match unilateral outcomes [9], with inter-stage timing [17] and contralateral labral deterioration [19] not compromising results. Long-term data confirm durable improvement in patients ≥40 years [44], in global acetabular overcoverage (with higher revision risk) [33], and with capsular plication for microinstability [34], though psychiatric comorbidity [50] and severe ligamentous laxity [55] portend inferior outcomes. Contemporary techniques outperform earlier-era surgery [43][120], and cadaveric work confirms labral repair restores contact mechanics [52].
Periacetabular Osteotomy & Dysplasia¶
Hip preservation beyond arthroscopy is well represented, centered on periacetabular osteotomy (PAO) and related osteotomies. Long-term PROMs after PAO relate to preoperative cartilage T2 values and postoperative 3D morphology [1], and PAO with or without concomitant arthroscopy improves clinical and radiographic outcomes in borderline dysplasia [48], including at 10 years when combined with femoral osteochondroplasty [24]. Combined PAO plus arthroscopy enables high return-to-sport rates in competitive athletes [51][102] and in Ehlers-Danlos patients [20]. A review of Japanese femoral osteotomies (transtrochanteric rotational and curved varus) outlines joint-preservation principles for young patients [11]. Supporting the preservation theme, a Chinese guideline addresses minimally invasive management of femoral head osteonecrosis [66], and standardised reporting recommendations for non-traumatic osteonecrosis aim to improve study comparability [115].
Primary THA Techniques & Implants¶
Multiple studies evaluate primary total hip arthroplasty (THA) technology, approaches, and implants. Robotic arm-assisted THA shows less inflammation and earlier functional recovery than CT-based navigation [5], though a propensity-matched cost analysis questions the economic value of enabling technologies [89]. Direct anterior approach biomechanics are quantified with six-axis load sensing during femoral preparation [23], and MRI confirms comparable periacetabular muscle damage between SuperPATH and posterolateral approaches [96]. Bearing and stem choices are scrutinized: delta ceramic-on-ceramic versus ceramic-on-HXLPE bearings [27], vitamin E-blended polyethylene wear at 10 years [65], approach-specific bearing configuration recommendations [111], and short femoral stems showing mid-term safety in 5,876 cases [80] with predictable fixation patterns for calcar-guided designs [31]. Cortical hypertrophy after short stems is largely benign [59], and prior ipsilateral hip arthroscopy does not compromise subsequent THA outcomes [32].
Revision THA & Periprosthetic Complications¶
Revision surgery and periprosthetic complications form a substantial cluster. Component-retention 'mix and match' strategies reduce morbidity in revision THA [12], with modular trabecular cup-cage systems [83], cemented dual-mobility in porous tantalum shells [62], and custom-made acetabular implants for severe defects [70] addressing major bone loss. Short-stem revision with primary stems is feasible [81], resurfacing-to-THA revision achieves outcomes comparable to primary THA [67], and proximal femoral replacement outcomes differ by oncologic versus non-oncologic indication [98]. Periprosthetic fracture prevention [21] and age-dependent risk quantification after cementless THA [106] are highlighted, with early surgery for periprosthetic fracture not reducing mortality [124]. Infection management spans single- versus two-stage revision effectiveness [63], network meta-analysis of one-, 1.5-, and two-stage strategies [95], partial prosthetic exchange [84], DAIR with vacuum-assisted intra-articular antibiotics [56], antibiotic holiday reconsideration [38], and cefazolin superiority in aseptic revision [112]. Loosening assessment [97] and anteversion imaging [114] support revision decision-making, while revision indication predicts early mortality [113] and frailty indices refine risk stratification [86][123].
Hip Fracture & Geriatric Trauma¶
Femoral neck and acetabular fracture care in older adults features prominently. Capacity-related surgical delay increases mortality after hip fracture [78], after-hours hemiarthroplasty carries adverse perioperative outcomes [103], and cemented versus uncemented fixation varies widely across US regions [93]. Frailty tools predict 30-day mortality [86], and machine learning identifies secondary fragility fracture risk [60]. Global initiatives address immediate weight-bearing implementation [41], palliative care options for frail patients [118], and equity in hip fracture guidelines [28]. For acetabular injuries, geriatric fracture treatment comparisons favour structured algorithms [30][91], anterior fix-and-replace strategies [100] and approach comparisons [101] inform surgical decision-making, precontoured plate fit is assessed morphometrically [104], and minimally invasive endoscopic fixation techniques are emerging [127]. Associated injuries [22] and persistent hypercoagulability [99] add clinical context, alongside diagnostic workup for occult neck fractures [90].
Arthroplasty Systems & Perioperative Care¶
Health-systems and perioperative research rounds out the digest. Registry and projection studies forecast growing revision burden globally [3] and report a decade of Irish arthroplasty practice [4]. Care delivery studies examine outpatient and ambulatory surgery economics and safety [77][85][110], fast-track/ERAS consensus recommendations [39], and arthroplasty implementation in Greenland [40]. Perioperative medical management includes duloxetine analgesia [69], COX-2 inhibitor safety in anticoagulated patients [109], bone cement implantation syndrome [82], and comorbidity impacts such as peripheral artery disease [105], gastrointestinal bleeding history [88], and psychological distress [108]. Length-of-stay determinants [107], digital proficiency for PROM collection [116][117], and spine-hip arthroplasty interaction [87] inform care pathways, while metal-on-metal surveillance reduction [94] and heterotopic ossification prophylaxis duration [75] address long-term monitoring.
Articles by Theme¶
Hip Arthroscopy Outcomes & Techniques (16)¶
6. Brinkman JC, Monty TL, Sparks CA, et al. Comparable Survivorship and Clinically Significant Outcome Achievement With Both Interportal and T-Type Capsulotomy in Contemporary Hip Arthroscopy: A Propensity Score–Matched Analysis. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261485697
In this propensity score, matched cohort of hip arthroscopy patients with ≥2-year follow-up, interportal and T-type capsulotomy (all with capsular closure) were compared on PROs (HOS-ADL, HOS-SSS, iHOT-12), achievement of clinically significant outcome thresholds, and reoperation-free survival. Both capsulotomy configurations yielded comparable survivorship and clinically meaningful outcome achievement. This supports surgeon flexibility in capsulotomy choice when the capsule is routinely closed.
9. Cao Z, Gao G, Kim J, et al. Staged and Simultaneous Bilateral Hip Arthroscopy for Femoroacetabular Impingement Syndrome Achieves Clinical Outcomes Comparable With Unilateral Surgery at a Minimum 2‐Year Follow‐Up: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70641
This systematic review compared patient-reported outcomes and reoperation rates between bilateral (staged or simultaneous) and unilateral hip arthroscopy for femoroacetabular impingement syndrome with minimum 2-year follow-up. Bilateral hip arthroscopy achieved clinical outcomes comparable to unilateral surgery. This supports offering bilateral procedures without concern for inferior functional results, informing surgical planning for patients with bilateral impingement.
13. Gao G, Lin W, Zhu Y, et al. Healed Acetabular Labrum on Postoperative Magnetic Resonance Imaging Is Associated With Superior Achievement of Clinically Significant Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Minimum 2‐Year Follow‐Up. Arthroscopy 2026. doi:10.1002/arj.70611
This retrospective study of 220 patients with minimum 2-year follow-up stratified hip arthroscopy patients by postoperative labral healing status on MRI (unchanged, improved, healed, worsened). A healed acetabular labrum on postoperative MRI was associated with superior achievement of clinically significant outcomes on pain and modified Harris Hip Score measures. This underscores the importance of achieving labral healing intraoperatively to maximise patient benefit after arthroscopy for femoroacetabular impingement.
15. Johnson BT, Metz AK, Trutner ZD, et al. Periportal Capsulotomy Shows Promising Short‐Term Outcomes Compared With an Interportal Capsulotomy for the Treatment of Femoroacetabular Impingement Syndrome in Borderline and Dysplastic Female Patients. Arthroscopy 2026. doi:10.1002/arj.70634
This retrospective single-surgeon study compared interportal capsulotomy with capsular-sparing periportal capsulotomy in borderline and dysplastic female patients undergoing hip arthroscopy for femoroacetabular impingement. Periportal capsulotomy showed promising short-term patient-reported outcomes compared with interportal capsulotomy. This suggests a capsular-sparing approach may be advantageous in dysplastic-prone patients, though longer-term data are needed.
17. Messina JC, Li ZI, Kingery MT, et al. Duration Between Staged Bilateral Hip Arthroscopy Does Not Affect Outcomes in Patients With Femoroacetabular Impingement Syndrome. Arthroscopy 2026. doi:10.1002/arj.70621
In a single-surgeon series of 76 patients (152 hips) undergoing staged bilateral hip arthroscopy for femoroacetabular impingement syndrome, outcomes were compared between patients staged <1 year versus ≥1 year apart. At 2-year follow-up, modified Harris Hip Scores, Nonarthritic Hip Scores, revision rates, and conversion to total hip arthroplasty did not differ between groups. Surgeons and patients can therefore schedule the second-stage procedure based on clinical recovery and preference rather than concern that a longer or shorter interval compromises outcomes.
19. Cao Z, Gao G, Lin W, et al. Progressive Contralateral Acetabular Labral Deterioration Occurs Between Staged Bilateral Hip Arthroscopies for Femoroacetabular Impingement Syndrome Without Affecting Clinical Outcomes. Arthroscopy 2026. doi:10.1002/arj.70605
In 46 patients undergoing staged bilateral hip arthroscopy for femoroacetabular impingement syndrome, MRI of the contralateral hip obtained at each stage documented progressive labral deterioration (changes in labral size and tear classification) between procedures. Despite this radiographic progression, 2-year patient-reported outcomes, rates of achieving minimal clinically important difference, and patient acceptable symptom state were unaffected. The results suggest contralateral labral worsening is common but does not justify altering the timing of the second surgery based on imaging alone.
26. Messer KP, Pinchok AR, Hernandez EJ, et al. Labral Repair and Reconstruction Yield Comparable Patient‐Reported Outcomes at Short‐ to Mid‐Term Follow‐Up During Primary Hip Arthroscopy: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70625
This systematic review of six Level III studies compared labral repair versus labral reconstruction during primary hip arthroscopy (1628 repairs, 679 reconstructions) with 2.0-5.8 years follow-up. Both groups achieved significant PRO improvements exceeding minimal clinically important difference and patient acceptable symptomatic state thresholds (>70%), with no significant between-group differences. These findings support labral repair as the default, with reconstruction reserved for irreparable tissue, given comparable short- to mid-term outcomes.
33. Quesada‐Jiménez R, Maldonado‐Rosales A, Bomma KS, et al. Hip Arthroscopy in Patients With Global Acetabular Overcoverage Shows Significant 5‐Year Improvements but Poses a Higher Risk of Revision Surgery Compared With Matched Controls. Arthroscopy 2026. doi:10.1002/arj.70522
This prospective study evaluated minimum 5-year patient-reported outcomes after primary hip arthroscopy for femoroacetabular impingement syndrome in patients with global acetabular overcoverage, compared against propensity-matched controls without overcoverage. Patients with global acetabular overcoverage achieved significant 5-year improvements in pain and function scores, but carried a higher rate of revision surgery than matched controls. Clinically, hip arthroscopy can offer durable benefit in this population, but surgeons should counsel patients with global acetabular overcoverage about elevated revision risk.
34. Bacon CJ, Auchterlonie RP, Woodward RM, et al. Outcomes of Capsular Plication as Part of Hip Arthroscopic Management for Surgically Identified Microinstability Are Comparable to Outcomes in Matched Controls. Arthroscopy 2026. doi:10.1002/arj.70558
This propensity-matched cohort study compared minimum 2-year outcomes of hip arthroscopy with capsular plication in patients with intraoperatively confirmed microinstability against matched controls without microinstability. Outcomes in the 208 microinstability hips treated with plication were comparable to controls across patient-reported scores and revision/reoperation rates. The findings support capsular plication as an effective strategy during hip arthroscopy for surgically identified microinstability, yielding results on par with standard arthroscopic management.
37. Brumm ZG, Chen KY, Pepic L, et al. Young Male Patients With Lower Tönnis Grade and Alpha Angle Are More Likely to Achieve Clinically Significant Outcome Improvement at 2 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome Using Periportal Capsulotomy. Arthroscopy 2026. doi:10.1002/arj.70635
This retrospective analysis of a prospectively collected database of 463 primary hip arthroscopies using periportal capsulotomy identified predictors of achieving clinically significant outcome improvement at 2 years for femoroacetabular impingement syndrome. Younger male patients with lower Tönnis grade and lower alpha angle were more likely to reach minimally clinically important difference, patient acceptable symptom state, and substantial clinical benefit thresholds. These findings can guide preoperative counseling by identifying patients most likely to achieve meaningful improvement with conservative capsule management.
43. Schab AR, Rana K, Wallace I, et al. Outcomes and Return-to-Sport Rates of Competitive Athletes Treated for Femoroacetabular Impingement Syndrome With Contemporary Hip Arthroscopy Techniques: A Matched Comparison to Early Techniques. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261479923
This matched cohort study compared patient-reported outcomes and return-to-sport rates in competitive athletes undergoing primary hip arthroscopy for femoroacetabular impingement syndrome using contemporary techniques (capsular repair with knotless labral repair/reconstruction) versus early techniques. Athletes achieved high return-to-sport rates with modern methods. Results support the use of contemporary capsular and labral management in athletic populations.
44. Lehman AC, Lee S, Berzolla E, et al. Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Patients Aged ≥40 Years Produces Durable Functional Improvement With Moderate Survivorship Compared With Younger Cohorts: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70557
A systematic review of 9 studies (451 patients, 467 hips) evaluated mid- and long-term outcomes of hip arthroscopy for femoroacetabular impingement syndrome in patients aged ≥40 years. Modified Harris Hip Scores improved substantially and remained durable at 5-10 years, though survivorship was moderate relative to younger cohorts. Age ≥40 alone should not preclude hip arthroscopy, but counseling should reflect somewhat more guarded longevity expectations.
50. Cameron RK, Jazrawi I, Montgomery SR, et al. Psychiatric Comorbidity Is Associated With Increased Failure Rates and Inferior Clinical Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome at a Minimum 10-Year Follow-up. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261480939
This retrospective cohort study followed 243 patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome (2010-2014) for at least 10 years, comparing outcomes between those with and without preoperative psychiatric comorbidity and psychotropic medication use. Psychiatric comorbidity was associated with increased failure rates (revision arthroscopy or conversion to total hip arthroplasty) and inferior patient-reported outcome scores. These results suggest psychiatric history should be considered during preoperative counseling and risk stratification for hip arthroscopy.
52. Birmingham P, Baker HP, Straszewski AJ, et al. Repair of Labral Tears in a Cadaveric Model Normalizes Acetabular Contact Pressure Distribution and Restores Dynamic Hip Motion. Arthroscopy 2026. doi:10.1002/arj.70524
In eight fresh-frozen cadaveric hips, contact pressures, contact areas, and dynamic 3D hip motion were compared across intact, torn (11-2 o'clock), and repaired labral states under 250 N axial loading. Labral tears increased superior peak contact stress by 27% and reduced total contact area by 21%, while labral repair reduced peak stress below intact levels and restored contact area and dynamic motion to near-normal values. This biomechanical evidence supports labral repair as a means of restoring native acetabular contact mechanics.
55. Patel DH, Quesada‐Jimenez R, Ko W, et al. Recovery Curves After Hip Arthroscopy for Femoroacetabular Impingement Are Slower for Patients With Severe Ligamentous Laxity: A Propensity‐Matched Study. Arthroscopy 2026. doi:10.1002/arj.70526
This propensity-matched study compared recovery trajectories after hip arthroscopy for femoroacetabular impingement and labral tears between patients with generalized ligamentous laxity (Beighton score ≥4) and matched controls without laxity, using multiple patient-reported outcome measures through minimum 2-year follow-up. Patients with severe ligamentous laxity, particularly high Beighton scores of 8-9, demonstrated slower recovery curves and lower rates of achieving clinically relevant thresholds (PASS and MCID). Surgeons should counsel lax patients that their postoperative recovery is likely to be more prolonged, though outcomes may still improve over time.
120. Mullins K, Filan D, Carton P. Has Surgical Evolution in Hip Arthroscopic Techniques Improved Patient-Reported Outcome After Treatment of Symptomatic Femoroacetabular Impingement (FAI). Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261484236
Single-surgeon prospective registry data compared 2-year outcomes of primary hip arthroscopy for femoroacetabular impingement between an early era (2010-2012) and a contemporary era (2020-2022), assessing survivorship, reoperation, PROMs, range of motion, and satisfaction. The study tested whether a decade of technical advancements in hip arthroscopy translated into measurable clinical benefit. The results inform whether contemporary arthroscopic technique offers improved treatment value for symptomatic FAI patients.
Periacetabular Osteotomy & Dysplasia (9)¶
1. Shoji T, Ueki S, Kaneta H, et al. Factors associated with long-term patient-reported outcomes after periacetabular osteotomy. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06522-x
In 42 hips with early-stage osteoarthritis from developmental dysplasia followed >10 years after periacetabular osteotomy, the authors assessed long-term patient-reported outcomes (including the JHEQ) and their associations with preoperative cartilage T2 values and postoperative three-dimensional hip morphology on CT. The study sought to clarify how preoperative cartilage degeneration and postoperative correction relate to long-term PROMs. Clinically, the findings may help identify which patients are most likely to sustain good long-term subjective outcomes after PAO and guide patient selection and counseling.
11. Motomura G, Nakashima Y. Femoral osteotomies for hip joint preservation. International Orthopaedics 2026. doi:10.1007/s00264-026-06982-1
This narrative review examined Japanese femoral osteotomies, transtrochanteric rotational osteotomy and curved varus osteotomy, for hip joint preservation, covering their development, indications, and outcomes. Long-term studies showed favourable results, primarily for osteonecrosis of the femoral head. These techniques remain valuable joint-preserving options for young, active patients who wish to avoid or delay total hip arthroplasty.
20. Kollmorgen R, Wilson H, Martin R, et al. Ehlers‐Danlos Patients Achieve High Satisfaction and Clinically Meaningful Outcomes After Combined Hip Arthroscopy and Periacetabular Osteotomy: A Comparative Study With Non‐Ehlers‐Danlos Syndrome Patients. Arthroscopy 2026. doi:10.1002/arj.70608
This comparative study evaluated PROMIS and iHOT-12 outcomes after combined hip arthroscopy and periacetabular osteotomy in patients with Ehlers-Danlos syndrome versus a matched non-EDS cohort with hip dysplasia or instability. EDS patients achieved high satisfaction and clinically meaningful improvements, with outcomes comparable to non-EDS patients on MCID, PASS, and maximal outcome improvement benchmarks. Combined HA+PAO can therefore be offered to appropriately selected EDS patients with reasonable expectation of benefit.
24. Shah VP, O’Connor KP, Harris M, et al. Periacetabular Osteotomy and Combined Open Femoral Head-Neck Junction Osteochondroplasty: A Concise Follow-up of a Previous Report at a Mean 10-Year Follow-up. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261476760
This level 3 cohort study compared 38 patients undergoing periacetabular osteotomy combined with femoral head-neck junction osteochondroplasty against 42 matched PAO-only controls at a mean 10-year follow-up. Outcomes included mHHS and WOMAC scores, reoperation rates, radiographic measures, survivorship, and complications, with failure defined by MCID/PASS thresholds, conversion to THA, or reoperation. The study addresses whether addressing concomitant femoroacetabular impingement in dysplastic hips improves long-term survivorship and clinical outcomes.
48. Principe F, Martedi JC, Palladino MC, et al. Borderline Hip Dysplasia Shows Significantly Improved Clinical and Radiographic Outcome When Treated With Periacetabular Osteotomy, With or Without Concomitant Hip Arthroscopy. Arthroscopy 2026. doi:10.1002/arj.70527
This retrospective study compared periacetabular osteotomy (PAO) alone versus PAO with concomitant hip arthroscopy in 73 patients with borderline hip dysplasia, subclassified by anterior/posterior wall deficiency. Borderline dysplasia treated with PAO, with or without arthroscopy, showed significantly improved clinical and radiographic outcomes. Results support PAO as effective for borderline hip dysplasia and help clarify when adjunct arthroscopy is warranted.
51. Mansour A, Lemaster N, Jelmini J, et al. High Rate of Return to Sport in Competitive Athletes Undergoing Periacetabular Osteotomy With Concomitant Hip Arthroscopy. Arthroscopy 2026. doi:10.1002/arj.70523
This single-surgeon retrospective series evaluated return to sport in 44 competitive athletes (52 hips) who underwent combined hip arthroscopy and periacetabular osteotomy for hip dysplasia between 2016 and 2023, with a minimum 2-year follow-up. A high rate of return to sport was achieved, with most athletes returning at the same or higher level of competition relative to their preoperative status. The data support combined HA + PAO as a viable joint-preserving option for dysplastic hips in competitive athletes.
66. Zhang H, Li Z, Wang W, et al. Chinese clinical practice guidelines for minimally invasive hip preservation techniques for femoral head osteonecrosis (2025 edition). International Orthopaedics 2026. doi:10.1007/s00264-026-07014-8
A multidisciplinary panel developed a Chinese clinical practice guideline for minimally invasive hip preservation in adults ≤60 years with early- to mid-stage (ARCO I, IIIA) nontraumatic femoral head osteonecrosis, based on a literature search through May 2025 and Oxford Centre for Evidence-Based Medicine grading. Nine recommendations were issued, all graded C or D, emphasizing individualized, staging-centered, dynamic multidisciplinary pathways. Clinicians should tailor hip-preserving treatment to stage, age, and lesion characteristics rather than apply a uniform approach.
102. Whiting Z, Maheshwer B, Brown M, et al. Combined Periacetabular Osteotomy and Hip Arthroscopy Results in High Return to Sport Rates in Contact and Noncontact Athletes With Hip Dysplasia. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261466470
This retrospective case series of 103 athletic hips in 84 young patients with hip dysplasia (LCEA <25°) examined return to sport after combined periacetabular osteotomy and hip arthroscopy between 2016 and 2023. The study found high return-to-sport rates in both contact and noncontact athletes, exceeding or matching rates previously reported for either procedure alone. These results support combined PAO with arthroscopy as an effective strategy for dysplastic athletes seeking to resume sports.
115. Cheng EY, Mirzaei A, Sierra RJ, et al. Toward Standardized Reporting in Non-Traumatic Osteonecrosis of the Femoral Head: Recommendations for Clinical Study Design and Reporting. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.032
The authors developed a disease-specific reporting framework for clinical studies of non-traumatic osteonecrosis of the femoral head (ONFH) through critical literature appraisal and expert consensus, defining minimum and optimal reporting standards across key methodological domains. The framework addresses heterogeneity in terminology, staging, lesion characterization, treatment description, and outcome reporting that currently limits cross-study comparability. Adoption of these standards could improve study interpretability, enable meaningful meta-analysis, and strengthen the evidence base guiding ONFH treatment.
Primary THA Techniques & Implants (11)¶
5. Omichi Y, Goto T, Yoshida G, et al. Less inflammation and early functional recovery after total hip arthroplasty performed with robotic arm assistance than with computed tomography-based navigation: a propensity score-matched comparative study. International Orthopaedics 2026. doi:10.1007/s00264-026-07042-4
In a propensity score, matched comparison of 158 hips each, robotic arm-assisted THA (with single reaming) was compared with CT-based navigation THA (multiple reamings) via an anterolateral supine approach regarding inflammatory response, pain, and functional recovery. Robotic assistance was associated with less postoperative inflammation (lower CRP) and earlier functional recovery than navigation. This suggests robotic arm-assisted THA may offer a smoother early postoperative course, though longer-term clinical superiority remains unproven.
23. Iwasaki E, Baba T, Tashiro K, et al. Intraoperative six-axis loads during direct anterior approach total hip arthroplasty using a leg positioner: quantitative patterns across manoeuvres. International Orthopaedics 2026. doi:10.1007/s00264-026-07040-6
This prospective biomechanical study used a six-axis force sensor on the operative boot to quantify intraoperative lower-limb loads during femoral preparation in 95 leg positioner-assisted direct anterior approach total hip arthroplasties. Loads were measured at baseline, the extension endpoint, and final stem positioning after adduction, revealing quantitative patterns across these maneuvers. The data provide a reference for understanding soft-tissue and bony stresses during DAA-THA, potentially informing technique modifications and positioner-related complication avoidance.
27. Lee Y, Kang D, Kim H, et al. Comparative outcomes of delta-on-delta and delta-on-highly cross-linked polyethylene bearings in total hip arthroplasty: a nationwide cohort study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06502-1
This nationwide Korean cohort study of 15,299 primary total hip arthroplasties with Delta ceramic heads compared Delta-on-Delta ceramic versus Delta-on-highly cross-linked polyethylene bearings. Delta liner use rose markedly after 2007, and the Delta-on-HXLPE group showed a higher risk of periprosthetic joint infection. Surgeons using ceramic heads should favour Delta-on-Delta bearings, as adding HXLPE liners conferred no survival advantage.
31. Sonoda K, Kubo Y, Hara T. Preoperative factors associated with alignment change from planned metaphyseal- to diaphyseal-dominant fixation in calcar-guided short-stem total hip arthroplasty. International Orthopaedics 2026. doi:10.1007/s00264-026-07039-z
This study of 62 consecutive primary THAs with a calcar-guided short stem used CT-based 3D templating planned for metaphyseal-dominant fixation and identified preoperative factors associated with intraoperative deviation to diaphyseal-dominant fixation. Patient demographics, Dorr classification, neck-shaft angle, and planned stem depth parameters were analyzed as predictors. Recognizing these factors helps surgeons anticipate fixation-pattern changes that may affect offset and leg-length reconstruction.
32. Krautter J, Feil S, Thorey F. Comparable functional outcomes after total hip arthroplasty in patients with and without prior ipsilateral hip arthroscopy: A comparative cohort study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70590
This retrospective cohort study compared functional outcomes of total hip arthroplasty in 89 patients with prior ipsilateral hip arthroscopy versus 457 primary THA patients, with conversion intervals exceeding 6 months. Both groups improved significantly across all HOOS subscales, with no significant postoperative between-group differences except quality of life, which was slightly lower after prior arthroscopy. Prior hip arthroscopy does not appear to compromise THA outcomes, though modestly lower QoL scores may warrant counseling.
59. Schwarz PM, Stützle S, Stadler C, et al. Cortical hypertrophies in cementless short stem total hip arthroplasty in young patients under 60 years and elderly patients over 75 years—analysis of outcome and risk factors for cortical hypertrophies. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06450-w
A retrospective analysis of 208 cementless short-stem total hip arthroplasties compared outcomes in patients under 60 versus over 75 years with and without radiographic cortical hypertrophy. Younger patients with cortical hypertrophy showed significantly better Harris Hip and Oxford Hip Scores than those without, while age over 75, presence of cortical hypertrophy showed no significant outcome impact; risk factors included delta hip offset, canal fill index, and stem alignment. Cortical hypertrophy after short-stem THA appears to be a benign remodeling phenomenon rather than a sign of failure, and its presence should not prompt concern in younger patients.
65. Demir E, Rasuli M, Nienhaus M, et al. Long-term results of a vitamin E–blended polyethylene liner in total hip arthroplasty: a minimum ten year computer aided design based evaluation of wear and component positioning. International Orthopaedics 2026. doi:10.1007/s00264-026-06997-8
A retrospective study of 57 hips with a vitamin E, blended polyethylene monoblock acetabular component followed ≥10 years used automated CAD-based software to measure wear and cup positioning. Mean wear rates were low (26.9 µm/year at 5 years, 18.2 µm/year at 10 years) and below osteolysis-associated thresholds, with stable inclination. This supports the long-term durability of vitamin E, blended polyethylene liners in total hip arthroplasty.
80. Delaunay C, Brand C, Bouché P, et al. Use of Short Femoral Stems in Primary Total Hip Arthroplasty: A Mid-Term Safety Analysis: Prospective series of 5,876 cases at 4.4-year average follow-up. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2025.104565
This prospective multicenter series from the French SOFCOT/RENACOT registry analyzed 5,876 short femoral stem primary THAs performed between 2011 and 2023, with average follow-up of 4.4-4.7 years. Revision analysis showed SFS accounted for 8.7% of linked revisions, with most being cementless designs. The mid-term findings support the safety of short femoral stems in primary THA, including in older patients.
89. Williams JL, Gonzalez-Bravo AE, Moriarty JP, et al. Cost Consequences of Enabling Technologies in Primary Total Hip Arthroplasty: A Propensity Matched Cohort Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.059
A propensity-matched cohort study compared standardised episode-of-care costs for 513 technology-assisted primary total hip arthroplasties (handheld navigation, fluoroscopic navigation, or robotics) against matched manual procedures, covering index hospitalization and 90-day postoperative costs. The findings inform whether the growing adoption of surgical guidance systems is economically justified. Clinically, the results help hospitals and surgeons weigh the cost implications of adopting enabling technologies in routine THA practice.
96. Gan F, Zhang Q, Luo H, et al. Magnetic Resonance Imaging Assessment of Muscle Damage After Postero-lateral Versus Supercapsular Percutaneously-Assisted Total Hip Approaches: A Randomized Controlled Trial. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.056
This randomised controlled trial compared MRI-assessed periacetabular muscle damage 12 months after total hip arthroplasty via the supercapsular percutaneously-assisted (SuperPATH) versus postero-lateral approach in 82 patients. The minimally invasive approach better preserved the quadratus femoris muscle (less fatty infiltration, less atrophy, superior tendon continuity), with no differences in other periacetabular muscles. Clinically, this objective soft-tissue evidence may inform surgical approach selection, though functional relevance requires correlation with clinical outcomes.
111. Cochrane NH, Panos JA, Khela MS, et al. There Is No One-Size-Fits-All: Surgical Approach Dictates Optimal Bearing Surface Configuration Choice in 30,000 Total Hip Arthroplasties Over 25 Years. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.018
A single-institution series of 30,246 primary total hip arthroplasties over 25 years evaluated 10-year dislocation-free survivorship stratified by both surgical approach (posterior, anterolateral, direct anterior) and bearing configuration (flat/neutral, elevated-rim, dual-mobility polyethylene). Dislocation risk varied by approach such that no single bearing configuration was universally optimal, yielding approach-specific bearing recommendations. Bearing selection should be tailored to the surgical approach rather than applied uniformly.
Revision THA & Periprosthetic Complications (22)¶
12. Ashkenazi I, Khury F, Konan S. Mix and match strategies in revision total hip arthroplasty: a review of techniques and outcomes. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06510-1
This narrative review evaluated six component-retention ('mix and match') strategies in revision total hip arthroplasty across acetabular and femoral subsites. Retaining stable metal-on-metal shells with dual-mobility bearings produced very low dislocation rates (0%-4%), cemented liners showed high mid-term survivorship, and trunnion adapter sleeves demonstrated reliable 10-year survivorship (85%). These targeted strategies can reduce operative morbidity and preserve host bone stock in selected revision scenarios.
21. Lamb J, Whitehouse M. Prevention of Periprosthetic Fractures. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00882
This review examines the mechanisms, classification, and prevention of periprosthetic fractures, focusing on periprosthetic proximal femoral fractures after total hip arthroplasty. Registry projections indicate these fractures will rise substantially as arthroplasty volumes grow and the implanted population ages, with mortality rivaling hip fragility fractures and compromised implant survival after fixation. The authors advocate prevention as an integral, multidisciplinary component of arthroplasty care.
38. Ascione T, Balato G, Pagliano P, et al. Reimplantation in 2-Stage Exchange: Breaking the Dogma of the 2-Week Antibiotic Holiday. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01550
This review article challenges the traditional 2-week antibiotic holiday before reimplantation in 2-stage exchange for periprosthetic joint infection, examining the evidence for timing decisions. Available data show no clear outcome benefit from an antibiotic holiday, while continuous antibiotic therapy shortens treatment and improves cure rates, particularly in immunocompromised patients. The authors recommend basing reimplantation timing on clinical signs of infection resolution combined with declining serologic and synovial markers rather than a fixed antibiotic-free interval.
56. Li M, Wang B, Yin Z, et al. DVIA technique for acute periprosthetic joint infection: a surgical technique and case series. Arthroplasty 2026. doi:10.1186/s42836-026-00430-6
This retrospective single-center case series of 31 patients (19 hips, 12 knees) described and evaluated a modified DAIR technique (DVIA) for acute periprosthetic joint infection, combining debridement with implant retention, vacuum sealing drainage, and intra-articular antibiotic infusion between 2019 and 2023. Monitoring of inflammatory markers and intra-articular antibiotic concentrations demonstrated infection control with improving functional scores (KSS, HHS, SF-36) over follow-up. The technique appears feasible and promising for acute PJI, though larger comparative studies are needed to confirm superiority over standard DAIR.
62. Loppini M, Di Matteo V, Bulgarelli A, et al. Cemented dual mobility component in newly implanted porous tantalum shells for severe acetabular defects: medium-term outcomes from a high-volume single-surgeon series. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06498-8
A single-surgeon series evaluated cemented dual mobility components implanted into newly placed porous tantalum acetabular shells for severe acetabular bone defects in revision total hip arthroplasty (2014-2020). Medium-term results demonstrated satisfactory reintervention-free survival with acceptable clinical and radiographic outcomes. This construct offers a viable option for managing severe acetabular defects, particularly in patients with poor soft tissue quality at risk of dislocation.
63. Zhang C, Li Y, Su C, et al. Comparative effectiveness of single-stage versus two-stage revision for hip prosthetic joint infection: emulation of the INFORM target trial using electronic health record data. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06503-0
A target trial emulation of the INFORM randomised trial using electronic health record data from three Chinese tertiary hospitals compared single-stage versus two-stage revision in 754 adults with confirmed hip prosthetic joint infection. The retrospective cohort design with a protocolized, TARGET-guideline-compliant analysis provided comparative effectiveness estimates where randomised data are limited. The findings help guide surgical decision-making for hip PJI revision strategy in clinical practice.
67. Bauters M, Hormi-Menard M, Faure P, et al. Outcomes of revision from hip resurfacing to total hip arthroplasty: a matched comparative study with primary total hip arthroplasty at seven and a half years follow-up. International Orthopaedics 2026. doi:10.1007/s00264-026-07013-9
In a retrospective matched case-control study, 18 patients revised from hip resurfacing to total hip arthroplasty (0.42% of 5268 resurfacings) were compared with matched primary THA controls at a mean 7.5-year follow-up using Oxford Hip Score, Merle d'Aubigné-Postel, UCLA, and Joint Forgotten scores. The abstract's results were truncated, but the study aimed to determine whether functional outcomes after revision approach those of primary THA. The findings inform counseling of resurfacing patients regarding expectations after conversion to THA.
70. Babasiz M, Zellner AA, Babasiz T, et al. Custom-made acetabular implants for severe acetabular bone defects: implant evolution, mid-term clinical and radiographic outcomes, and complications in 154 consecutive patients over 18 years. Arthroplasty 2026. doi:10.1186/s42836-026-00425-3
A single-center retrospective study of 154 consecutive patients treated with custom-made acetabular components over 18 years for severe Paprosky 3A/3B defects (including pelvic discontinuity) reported mid-term clinical, radiographic, and complication outcomes with mean follow-up of ~35 months. The abstract's results were truncated, but the study also tracked implant design evolution over time. The data support custom-made acetabular components as a viable option for complex revision reconstruction where off-the-shelf implants are inadequate.
81. Kara S, Manon J, Van den Wyngart T, et al. Revising short-stem THA with either a new short stem or a primary stems: A feasible and durable strategy. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104645
In 44 revisions of failed Fitmore short-stem THA, most femoral revisions were accomplished with a new short stem (11 cases) or a standard primary stem (26 cases), with only 7 requiring dedicated revision stems. At a mean 69-month follow-up, functional scores were good (mean Harris Hip Score 82.3) and only 4.5% required re-revision. This supports revising failed short-stem THA without revision implants in the majority of cases, simplifying surgical planning.
83. Fahmy M, Abdel Karim M, Abo-Elsoud M, et al. Modular trabecular acetabular reconstruction in revision hip arthroplasty: Mid-term comparative evaluation of two cementless cup–cage systems. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104699
In a retrospective comparison of 80 revision THAs for Paprosky II-III acetabular bone loss, two modular cementless cup-cage reconstruction systems (40 patients each) were evaluated at mid-term follow-up with standardised technique and CT-based classification. Both systems achieved comparable functional recovery (Merle d'Aubigné-Postel scores) and radiographic implant stability without pelvic discontinuity cases. Modular porous acetabular reconstruction appears durable for major acetabular defects, with system choice yielding similar mid-term results.
84. Cabanillas I, Escudero-Sanchez R, Cobo J, et al. Partial prosthetic exchange in the management of chronic prosthetic hip joint infection: a systematic review. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104870
This systematic review synthesized evidence through February 2025 on partial prosthetic exchange, removing only the infected component while retaining the well-osseointegrated one, for chronic prosthetic hip joint infection. It examined infection eradication, complications, and patient selection across the available studies. The findings inform a component-retaining alternative to full exchange in selected chronic hip PJI cases, potentially avoiding the morbidity of removing well-fixed implants.
86. Parisier E, Koltenyuk V, Gupta N, et al. The Risk Analysis Index is Superior to the Modified 5-Factor Frailty Index for Predicting 30-Day Mortality Following Arthroplasty for Femoral Neck Fractures. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.055
In 14,913 patients undergoing hemiarthroplasty or THA for femoral neck fracture (2015-2020 national database), the Risk Analysis Index (RAI) and Modified 5-Item Frailty Index (mFI-5) were compared for predicting 30-day mortality. Both predicted mortality, but RAI demonstrated superior discrimination on receiver operating characteristic analysis. RAI should be preferred for preoperative frailty assessment and risk stratification in geriatric hip fracture arthroplasty.
94. Selim A, Saeed A, George A, et al. Reducing the Surveillance Burden in Metal-on-Metal Hip Arthroplasties: A Risk-Adapted Three-Tier Model Based on a Large Patient Cohort. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.065
This cohort study of 845 metal-on-metal hip resurfacings and large-head total hip arthroplasties developed a risk-adapted, three-tier surveillance pathway using logistic regression predictors of abnormal MRI or revision, in response to mandated UK MHRA follow-up. A hierarchical clinical risk score achieved moderate sensitivity (0.84) but modest specificity (0.51) and AUROC (0.67). Clinically, the model offers a framework to safely reduce unnecessary surveillance visits and investigations for lower-risk MoM hip patients.
95. Selim A, Ibrahim A, Saeed A, et al. One-, 1.5-, or Two-Stage Revision for Periprosthetic Hip and Knee Joint Infection? A Network Meta-Analysis Comparing Revision Strategies. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.069
This Bayesian network meta-analysis of 54 studies (10,055 patients) compared one-, 1.5-, and two-stage revision strategies for chronic periprosthetic joint infection of the hip and knee. Both one- and 1.5-stage revisions showed significantly lower odds of reinfection compared with two-stage revision. Clinically, the findings challenge the traditional preference for two-stage exchange and support consideration of single-stage approaches in appropriate patients.
97. Hopman AG, Blankevoort L, Amanatullah DF, et al. Intraoperative Assessment of Component Loosening in Hip Arthroplasty: An International Delphi Consensus. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.003
A three-round international Delphi study of 37 revision hip surgeons from 32 countries established expert consensus on standardised intraoperative tests for component loosening in total hip arthroplasty, reaching agreement on 15 of 48 statements with strongest agreement for visible component motion under compression, distraction, and rotation. The resulting framework provides a consensus-based reference standard for future studies of preoperative loosening diagnostics. Clinically, it guides surgeons on which intraoperative maneuvers should be used to confirm loosening before revision decisions.
98. Kurapatti M, Shah A, Tao B, et al. Proximal Femoral Replacement Outcomes for Oncologic Versus Non-Oncologic Indications: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.004
This systematic review and meta-analysis of 42 studies (2,804 proximal femoral replacements; 2,081 oncologic vs 723 non-oncologic) pooled complications, revisions, amputations, implant survivorship, and patient survival using random-effects models. The pooled overall complication rate was 27%, with no significant difference between oncologic and non-oncologic indications, despite non-oncologic patients being older (72 vs 54 years). The findings support expanding PFR use beyond tumour reconstruction to complex non-oncologic proximal femoral failures, with comparable complication expectations.
106. Griffith K, Telang SS, Palmer RC, et al. Quantifying the Age-Dependent Risk of Periprosthetic Femoral Fracture Following Cementless Total Hip Arthroplasty: An Analysis using Age as a Continuous Variable. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.067
Using a national database of 524,119 primary cementless total hip arthroplasties, restricted cubic spline modeling with bootstrap simulation was applied to age as a continuous variable to identify a threshold for 90-day periprosthetic femoral fracture (PPFx) risk. The analysis quantified an age cutpoint beyond which PPFx risk rose significantly, providing continuous adjusted risk estimates across ages 20 to 89. These findings can guide age-based decision-making regarding fixation choice and perioperative fracture precautions in cementless THA.
112. Panos JA, Mallinger BD, Virk A, et al. Increased Risk of Periprosthetic Joint Infection Following Aseptic Revision Hip and Knee Arthroplasty With the Use of Non-Cefazolin Alternative Antibiotics. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.022
A single-institution cohort of 5,993 aseptic revision hip and knee arthroplasties (2000-2024) used Cox regression to examine periprosthetic joint infection (PJI) risk by perioperative antibiotic type, postoperative oral antibiotic regimen, and unexpected positive culture status. Non-cefazolin alternative prophylaxis was associated with increased PJI risk compared with cefazolin. The data support cefazolin as preferred prophylaxis in aseptic revision surgery when feasible and inform management of postoperative oral antibiotics and unexpected positive cultures.
113. Restrepo DJ, Gonzalez-Bravo AE, Guarin Perez SF, et al. Revision Indication Is Associated with Early Mortality After Revision Total Hip Arthroplasty: A Population-Based Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.023
A population-based cohort of 8,667 revision total hip arthroplasties performed at a single institution from 1997 to 2023 was analyzed for 30- and 90-day mortality using Kaplan-Meier and adjusted Cox models. Mortality was 0.5% at 30 days and 0.9% at 90 days, with periprosthetic fracture revision showing the highest 90-day mortality (2.6%) and aseptic loosening the lowest (0.4%). The indication for revision is a key mortality risk factor, suggesting perioperative risk stratification and counseling should be tailored to the reason for revision.
114. Edelstein A, Smitterberg CW, Amanatullah DF, et al. Assessment of Acetabular Component Anteversion Following Total Hip Arthroplasty: Current Imaging Techniques and Limitations. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.026
This narrative review examined radiographic and CT-based techniques for measuring acetabular component anteversion and inclination after total hip arthroplasty, focusing on precision, repeatability, and the influence of pelvic position and spino-pelvic mechanics. Commonly used radiographic methods (Woo and Morrey, Lewinnek, Liaw, Widmer) show reasonable correlation with CT-based assessments, though no single technique is clearly superior. Clinicians should recognize the limitations of each measurement method, particularly in patients with abnormal spino-pelvic mechanics, when evaluating component position for instability or wear.
123. Swaminathan N, Welsh C, Wagner P, et al. Modified 6-Factor Frailty Index Enhances Risk Stratification in Revision Total Hip Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.036
This retrospective NSQIP cohort study of 10,040 revision total hip arthroplasties compared a novel 6-item modified frailty index (adding hypoalbuminemia to mFI-5) against the standard mFI-5 for predicting 30-day adverse outcomes. The mFI-6 showed greater discrimination than mFI-5, with both mild and severe hypoalbuminemia associated with worse outcomes across frailty strata. Incorporating albumin into frailty assessment may enhance preoperative risk stratification for revision THA.
124. Papalia AG, Ricotti RG, Frappa N, et al. Early Surgical Management of Periprosthetic Hip Fracture Does Not Reduce Mortality or Cardiopulmonary Complications: A Propensity-Matched Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.035
This propensity-matched analysis of 2,098 patients per cohort used a national database to compare early (≤2 days) versus delayed (>2 days) revision THA for periprosthetic proximal femur fractures. Mortality at 30 days, 90 days, and 1 year, as well as cardiopulmonary and wound complications, did not differ between cohorts. Early surgery for periprosthetic hip fractures may not reduce mortality, challenging extrapolation of hip fracture timing paradigms to this population.
Hip Fracture & Geriatric Trauma (18)¶
14. Wong RMY, Yang M, Zhao C, et al. The Current Landscape of Fragility Fracture Care in the People’s Republic of China. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00865
This review summarized the current landscape of fragility fracture care in China, highlighting robotic assistance, acute total hip arthroplasty or combined hip procedures for acetabular fragility fractures, orthogeriatric comanagement, and the high prevalence of sarcopenia. Multidisciplinary, orthogeriatric-centered care emerged as fundamental to management. The clinical implication is that fragility fracture programs should integrate comanagement models and consider emerging technologies and arthroplasty-based solutions.
22. Mahissarakul P, Lohakitsathian C, Sudhasaneya V, et al. Association of knee ligament injury with pelvic and acetabular fractures: a retrospective cohort study. International Orthopaedics 2026. doi:10.1007/s00264-026-07047-z
This retrospective cohort of 328 patients with pelvic or acetabular fractures at a tertiary trauma center determined the incidence of associated knee ligament injuries and identified which fracture patterns carry highest risk. Knee ligament injuries were frequently overlooked during initial high-energy trauma management, contributing to delayed diagnosis and long-term disability. The findings support routine knee examination and vigilance in pelvic/acetabular trauma patients, particularly those with specific fracture patterns.
28. Mulakaluri A, Snyder EM, Young B, et al. Race, ethnicity, and language are underreported in hip fracture CPGs. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06496-w
This review examined racial, ethnic, and linguistic representation among the 196 studies underlying the AAOS Clinical Practice Guideline for hip fractures in older adults. Only 6.12% reported race/ethnicity data and 4.59% reported patient language, with virtually no use of linguistically or culturally adapted outcome measures. The evidence base for hip fracture guidelines is sociodemographically underreported, limiting the generalizability and equity of guideline-directed care.
30. Mamoutakis I, Horst K, Alabdulrahman H, et al. Management and outcome of displaced acetabular fractures in the oldest-old: a retrospective analysis of orif and acute total hip arthroplasty. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06511-0
This retrospective single-center cohort study compared ORIF versus acute total hip arthroplasty (± osteosynthesis) for displaced acetabular fractures in patients aged ≥70 years, before and after implementation of a treatment algorithm favoring THA in elderly and comorbid patients. The primary outcome was time to postoperative mobilization, with secondary outcomes including pain, complications, mortality, and conversion to THA after initial ORIF. The results support algorithm-driven THA use in the oldest-old, potentially improving early mobilization and reducing secondary conversion surgery.
41. Mao W, Jiang J, Shi Z, et al. Bridging the Global Implementation Gap in Immediate Weight-Bearing After Hip Fracture Surgery. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00980
A multidisciplinary group of 31 experts from 15 countries developed the WAIT-Free Consensus through a 3-round Delphi process to promote immediate weight-bearing as tolerated after hip fracture surgery in regions where it is not routinely practiced. The statement contains 13 recommendations across 4 domains, including shared decision-making and mobility-based patient stratification. It offers a structured framework for safely implementing early mobilization in settings representing over half the world's population.
60. He S, Wu D, Jiang D, et al. Secondary fragility fractures after hip fracture surgery in four thousand, four hundred and eighteen older adults: risk factors and internal validation of an interpretable machine-learning model. International Orthopaedics 2026. doi:10.1007/s00264-026-07002-y
A retrospective study of 4,418 adults aged 65 years or older who underwent surgery for a first low-energy hip fracture developed and internally validated an interpretable XGBoost machine-learning model predicting three-year secondary fragility fracture risk. Secondary fragility fractures occurred in 13.4% of patients, with risk factors including older age, osteoporosis, low BMI, female sex, cardiovascular disease, visual impairment, and syncope. The model enables individualized postoperative risk stratification to target prevention strategies such as osteoporosis treatment and fall reduction in high-risk patients.
78. King S, Wakefield S, Giannoudis V, et al. Effects of Capacity-Related Delay to Hip Fracture Surgery on Mortality. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00596
This retrospective cohort study of 2,358 operatively managed hip fracture patients aged ≥65 years at a UK teaching hospital examined mortality associated with capacity-related surgical delays (>36 hours from ED presentation), excluding medically delayed cases. Capacity-related delay was associated with increased 30-day and 365-day mortality, with propensity-score matching and multivariable regression used to control confounders. The findings underscore the clinical importance of hospital operative capacity in achieving timely hip fracture surgery.
82. MacElroy D, Park A, Rajkovic C, et al. Bone cement implantation syndrome following cemented hip arthroplasty for traumatic and oncologic indications: A systematic review and meta-analysis of incidence, risk factors, and outcomes. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104661
This PRISMA-compliant systematic review and meta-analysis pooled studies of bone cement implantation syndrome (BCIS) in cemented primary hip arthroplasty/hemiarthroplasty that used the Donaldson 2009 severity grading. It synthesized pooled incidence, risk factors, prophylactic measures, and perioperative outcomes under uniform criteria. The findings support standardised BCIS reporting and help identify high-risk patients and prophylactic strategies for cemented hip arthroplasty.
90. Maksoud A, Nkala M, Henderson K, et al. Evaluating the physical examination and diagnostic workup for occult NOF fractures in a district general hospital. Injury 2026. doi:10.1016/j.injury.2026.113656
This district general hospital audit evaluated the physical examination and diagnostic workup used to detect occult neck of femur fractures, examining how patients with negative initial imaging are investigated. The study assessed the performance of clinical assessment and subsequent imaging pathways in this setting. Clinically, it informs local protocols for identifying occult hip fractures and avoiding missed diagnoses in elderly patients.
91. Halvachizadeh S, Starr AJ, Bell L, et al. Comparison of Outcomes Based on Treatment Type for Geriatric Acetabular Fractures: A Systematic Review and Meta-Analysis. Injury 2026. doi:10.1016/j.injury.2026.113677
This systematic review and meta-analysis compared outcomes across treatment types (operative versus non-operative management) for geriatric acetabular fractures, synthesizing comparative studies in elderly patients. The analysis quantified differences in clinical outcomes by treatment strategy in this fragile population. Clinically, it provides evidence to guide shared decision-making regarding operative fixation versus conservative care in elderly acetabular fracture patients.
93. Anderson PA, Greenwald A, Riley C, et al. Variation in the Use of Cemented Versus Uncemented Hemiarthroplasty and Total Hip Arthroplasty for Treatment of Femoral Neck Fractures in the United States. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.063
This registry study analyzed 81,610 femoral neck fracture arthroplasties (hemiarthroplasty and total hip arthroplasty) in patients ≥65 years from the American Joint Replacement Registry (2012-2021) to assess regional and hospital-level variation in cemented femoral fixation and its impact on adverse outcomes. Cement was used in only 39.8% of cases despite guideline recommendations, with wide state-level variation (6-83%) and higher use at major teaching centers. Clinically, the findings highlight inconsistent guideline adherence and support efforts to standardize cementing practice where appropriate.
99. Clarke A, Tera Y, Skeith L, et al. Persistent Postoperative Hypercoagulability and Venous Thromboembolism Risk Following Pelvic and Acetabular Fractures: A Prospective Pilot Study. Injury 2026. doi:10.1016/j.injury.2026.113695
This prospective pilot study evaluated thromboelastometry/viscoelastic-based hypercoagulability testing after operative fixation of pelvic and acetabular fractures to determine whether hypercoagulability persists beyond the immediate postoperative period and relates to venous thromboembolism (VTE). As a pilot, it establishes feasibility and preliminary signal that persistent postoperative hypercoagulability may identify patients at elevated VTE risk. If validated, it could support risk-adapted, prolonged thromboprophylaxis in this high-risk fracture population.
100. Ivanova S, Keel F, Keel MJ, et al. Anterior Fix-and-Replace Strategy Using Direct Anterior and Pararectus approaches for Acetabular Fractures in Older Patients. Injury 2026. doi:10.1016/j.injury.2026.113700
This study describes an anterior 'fix-and-replace' strategy, combining direct anterior and pararectus approaches, for acetabular fractures in older patients, in which fixation is performed and, when indicated, converted to acute total hip arthroplasty through the same anterior exposure. The approach aims to address both fracture stabilisation and pre-existing or anticipated hip arthrosis in a single anterior procedure. It offers elderly patients a potential single-stage solution, though broader outcomes data are needed before widespread adoption.
101. Kaptan AY, Dolap MA, Göçer E, et al. Comparison of Anterior-Only and Combined Anterior-Posterior Approaches for Complex Acetabular Fractures. Injury 2026. doi:10.1016/j.injury.2026.113706
This comparative study evaluated anterior-only versus combined anterior-posterior surgical approaches for complex acetabular fractures, assessing radiographic reduction quality, complications, and functional outcomes. The findings inform approach selection, weighing the morbidity of dual approaches against the exposure needed for fracture reduction. Clinically, the results help guide surgeons in tailoring operative strategy for complex acetabular fracture patterns.
103. Beckers G, Deuschle J, Böcker W, et al. After-Hours Surgery Is Associated With Adverse Perioperative Outcomes Following Hemiarthroplasty for Femoral Neck Fracture. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.006
This retrospective cohort of 349 cemented hemiarthroplasties for displaced femoral neck fractures (all direct anterior approach) analyzed the effects of admission-to-surgery interval, operative timing, and surgeon subspecialty on perioperative outcomes. Delay beyond 24 hours was not independently associated with worse outcomes, but after-hours surgery independently predicted prolonged operative time (+12.3 minutes) and other adverse perioperative outcomes. The findings suggest prioritizing in-hours or adequately staffed operating capacity for hemiarthroplasty, rather than focusing solely on 24-hour timing targets.
104. Yoshida M, Iwata M, Takahashi N. Anatomical Fit of a Precontoured Suprapectineal Plate in Japanese Patients with Acetabular Fractures: A Three-Dimensional Morphometric Study. Injury 2026. doi:10.1016/j.injury.2026.113709
This three-dimensional morphometric study assessed the anatomical fit of a precontoured suprapectineal plate in Japanese patients with acetabular fractures using CT-based analysis. The study quantified plate-bone congruence and identified areas of mismatch relevant to the Japanese pelvic morphology. The results guide plate selection and potential design modifications for Asian populations, where Western-designed implants may fit less optimally.
118. Pelet S, Belzile É, Bérubé M, et al. Palliative care for hip fracture in elderly patients. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104901
This review addresses palliative care, non-surgical management with optimised pain control, for elderly patients with hip fracture, summarizing evidence mainly from the Netherlands and Canada, surgeon attitudes, and definitions of care. Growing literature supports palliative management for frail patients with severe comorbidity, but sociocultural, economic, and logistical obstacles hinder implementation by orthopaedic surgeons. Palliative hip fracture care is a legitimate addition to the treatment toolbox, best delivered in dedicated or orthogeriatric units with structured decision aids to identify appropriate candidates.
127. David G, Marc C, Steiger V, et al. The monoportal endoscopic intrapelvic approach for acetabular fracture fixation: a technical note. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104906
This technical note describes a fully extraperitoneal monoportal endoscopic technique for acetabular fracture fixation, adapted from the AIP approach through a single suprapubic mini-incision without fixed soft-tissue retraction. The method permits fracture reduction and buttress plate fixation under combined endoscopic and fluoroscopic guidance in selected fracture patterns. It offers a minimally invasive alternative to conventional open intrapelvic exposures.
Arthroplasty Systems & Perioperative Care (20)¶
3. Adolf J, Karlıdağ T, Citak M. Global Projection of Revision Total Hip and Knee Arthroplasty Through 2060. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00772
Using registry data from 17 countries with log-linear Poisson models (partially pooled, damped, with sensitivity analyses), the authors projected annual revision total hip and knee arthroplasty volumes through 2060. The 2024 modeled aggregate was about 185,921 revision THAs across these countries, with projections indicating a growing revision burden over the coming decades. These estimates support health-system planning for surgical capacity, implant supply, and costs associated with revision arthroplasty.
4. Farrell C, Davey M, Hickey P, et al. The first decade of data from the Irish National Orthopaedic Register: trends in hip and knee arthroplasty, implant utilisation and patient outcomes. International Orthopaedics 2026. doi:10.1007/s00264-026-07044-2
This descriptive analysis summarized the first decade (2015-2024) of the Irish National Orthopaedic Register, covering demographics, procedure volumes, implant utilisation and fixation, PROMs (e.g., Oxford scores), and clinical outcomes for hip and knee arthroplasty. It documents national trends in arthroplasty practice and patient outcomes since the register's establishment after the ASR implant recall. The findings underscore the value of registry monitoring for implant surveillance and quality improvement in arthroplasty care.
39. Totlis T, Kort N, Kort R, et al. Formal consensus on fast‐track hip and knee arthroplasty: ESSKA/EKA, EHS and APAS recommendations for optimised recovery pathways in joint replacement surgeries. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70594
This international formal consensus by ESSKA/EKA, EHS, and APAS involved 106 experts who developed and rated 63 statements across 37 questions on fast-track and enhanced recovery protocols for hip and knee arthroplasty. The process produced a unified, evidence-graded set of recommendations covering perioperative care principles and optimization of recovery pathways. Clinically, the document provides a practical, consensus-based framework for institutions seeking to implement or standardize fast-track joint replacement programs.
40. Bartosik M, Jørgensen N, Stoewe R. Implementing a hip arthroplasty program in Greenland, the autonomous territory of Denmark: challenges and outcomes. International Orthopaedics 2026. doi:10.1007/s00264-026-07034-4
This retrospective study reviewed the first 2 years of a newly implemented hip arthroplasty program in Greenland, analyzing 123 patients (129 procedures) against Danish register benchmarks. Elective and fracture patients were younger than Danish counterparts, with longer operative times, longer length of stay, and substantially higher complication rates, reflecting geographic and structural healthcare challenges. The findings highlight both the feasibility of establishing local arthroplasty capacity in remote regions and the need for targeted quality improvement during program maturation.
69. Ibrahim A, Abdelnabi M, Sheta RA. Duloxetine for postoperative pain management in total hip and knee arthroplasty: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-07176-6
This PRISMA-compliant systematic review and meta-analysis compared perioperative duloxetine versus placebo in total hip and knee arthroplasty patients, pooling VAS/NRS pain scores (converted to a 0-100 mm scale) and opioid consumption in morphine milligram equivalents. The abstract's quantitative results were truncated, but the review targeted pain at rest and with ambulation, opioid use, and adverse effects. Results are intended to clarify duloxetine's role as a multimodal analgesic adjunct and its opioid-sparing potential in joint arthroplasty.
75. Kirac M, Yozgatlı TK, Alizada R, et al. No Added Benefit of Nonsteroidal Anti-Inflammatory Drug Prophylaxis Beyond 15 Days for Heterotopic Ossification After Hip Arthroscopy. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261478430
This retrospective multicenter cohort of 1084 patients undergoing hip arthroscopy for femoroacetabular impingement compared diclofenac versus indomethacin prophylaxis at varying durations for heterotopic ossification prevention. No significant difference in HO incidence was found between agents or with prolonged treatment beyond 15 days. Clinically, extending NSAID prophylaxis beyond 15 days appears to offer no added benefit for HO prevention after hip arthroscopy.
77. Mont MA, Scuderi GR. Outpatient Arthroplasty: The Site of Service Has Changed, but the Work and Financial Burden Have Not. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.001
This commentary discusses the shift of total hip and knee arthroplasty from inpatient to outpatient and ambulatory settings, driven by removal from the CMS inpatient-only list and advances in perioperative care. The authors argue that although the site of service has changed, the surgeon work and financial burden remain unchanged. The piece highlights implications for reimbursement and perioperative care delivery as outpatient arthroplasty becomes the norm.
82. MacElroy D, Park A, Rajkovic C, et al. Bone cement implantation syndrome following cemented hip arthroplasty for traumatic and oncologic indications: A systematic review and meta-analysis of incidence, risk factors, and outcomes. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104661
This PRISMA-compliant systematic review and meta-analysis pooled studies of bone cement implantation syndrome (BCIS) in cemented primary hip arthroplasty/hemiarthroplasty that used the Donaldson 2009 severity grading. It synthesized pooled incidence, risk factors, prophylactic measures, and perioperative outcomes under uniform criteria. The findings support standardised BCIS reporting and help identify high-risk patients and prophylactic strategies for cemented hip arthroplasty.
85. Persaud SG, Kucherina A, Ortiz S, et al. Dual Eligibility Status Is Associated With Lower Surgeon Reimbursement Despite Greater Patient Complexity in Primary Total Joint Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.048
Using 2023 Medicare data (161,221 THA and 297,919 TKA procedures), surgeons were stratified into quartiles by the proportion of dual-eligible (Medicare-Medicaid) patients, and standardised reimbursement per procedure was compared via multivariable regression. Surgeons with higher dual-eligible panel proportions received lower mean reimbursement per procedure despite treating more complex, socioeconomically vulnerable patients. This suggests a reimbursement mismatch under value-based or standardised payment models that may penalize surgeons caring for disadvantaged populations.
87. Sauder N, Williams DL, Singh R, et al. Patients Requiring both Lumbar Spinal Fusion and Total Hip Arthroplasty Have Delayed Clinically Relevant Global Improvement Timelines. Findings from a Propensity Score-Matched Analysis of Time to MCID. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.049
A propensity score-matched analysis (183 patients with both lumbar spinal fusion and THA vs. 732 matched THA-only controls) used time-to-MCID methods for PROMIS PF-10a, PROMIS Global Physical, and HOOS-PS, and compared outcomes by surgical sequence. Patients requiring both procedures achieved clinically important improvement significantly later (e.g., PROMIS Global Physical 5.91 vs. 5.15 months). Surgeons should counsel patients with prior or planned spinal fusion to expect delayed recovery timelines after THA.
88. Botolin P, Helbing J, Khanuja HS, et al. Impact of Gastrointestinal Bleeding History on Postoperative Outcomes in Total Hip and Knee Arthroplasty: A Retrospective Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.057
This matched retrospective cohort study (6,420 THA and 9,688 TKA patients with prior GI bleeding vs. matched controls) assessed 90-day and 2-year complications including periprosthetic joint infection. GI bleeding history was not associated with 2-year PJI after THA but increased odds of mechanical loosening and revision; in TKA it was associated with higher 2-year PJI odds. A recent GI bleeding history should be considered in preoperative risk counseling, with attention to infection risk in TKA and aseptic loosening risk in THA.
94. Selim A, Saeed A, George A, et al. Reducing the Surveillance Burden in Metal-on-Metal Hip Arthroplasties: A Risk-Adapted Three-Tier Model Based on a Large Patient Cohort. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.065
This cohort study of 845 metal-on-metal hip resurfacings and large-head total hip arthroplasties developed a risk-adapted, three-tier surveillance pathway using logistic regression predictors of abnormal MRI or revision, in response to mandated UK MHRA follow-up. A hierarchical clinical risk score achieved moderate sensitivity (0.84) but modest specificity (0.51) and AUROC (0.67). Clinically, the model offers a framework to safely reduce unnecessary surveillance visits and investigations for lower-risk MoM hip patients.
105. Tummala S, Sontam TR, Thota DR, et al. Peripheral Artery Disease Is Associated With Increased Complications Following Primary Total Hip Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.005
A propensity-matched analysis of 5,552 pairs of primary total hip arthroplasty patients from a multinational database compared those with and without peripheral artery disease (PAD) diagnosed within one year preoperatively. PAD was associated with significantly higher risks of surgical site infection, periprosthetic joint infection, transfusion, anemia, and wound dehiscence at 30 and 90 days. Surgeons should recognize PAD as a marker of elevated wound and infectious complications and consider heightened perioperative surveillance in these patients.
107. Brito M, Heo KY, Rieger E, et al. Factors Associated with Increased Lengths of Stay After Total Hip Arthroplasty: A Single Institution Retrospective Review. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.027
A retrospective single-institution review of 463 total hip arthroplasty patients (2022-2025) identified patient- and hospital-level factors associated with later-day discharge, complemented by a qualitative chart review of discharge barriers. Same-day discharge was achieved in 93.5% of patients, and multivariable modeling delineated variables driving longer stays. The findings support use of tools like the RAPT score and targeted identification of social/operational barriers to expand same-day THA discharge programs.
108. Aalders MB, Z-T Ting T, D’Mello F, et al. Association of Recovery and Dissatisfaction with Psychological Distress in Patients Undergoing Total Knee and Hip Arthroplasty in South Australia: A Retrospective Cohort Study of 1,462 Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.010
A retrospective longitudinal cohort of 1,462 Australian total knee and hip arthroplasty patients assessed the association between psychological distress (EQ-5D-5L anxiety/depression) and patient-reported function, quality of life, and one-year dissatisfaction. Worse psychological symptoms were longitudinally associated with poorer postoperative function and quality of life, and preoperative distress predicted greater dissatisfaction at one year. The internationally observed link between psychological distress and inferior arthroplasty outcomes generalizes to the Australian context, supporting preoperative psychological screening.
109. Tummala S, Valencia A, Chen AF, et al. The Safety of Postoperative Selective Cyclooxygenase-2 Inhibitors in Chronically Anticoagulated Patients Undergoing Primary Total Hip Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.012
A national database study of chronically anticoagulated patients undergoing primary total hip arthroplasty (2015-2025) used propensity-score matching to compare postoperative selective COX-2 inhibitor exposure (celecoxib or meloxicam) versus non-exposure. Transfusion, readmission, and secondary thromboembolic, renal, and opioid outcomes were assessed through 180 days. The results address a key evidence gap by supporting the safety of selective COX-2 inhibitors as part of multimodal analgesia in anticoagulated THA patients.
110. Pang A, Zamzam M, Hodson N, et al. Equivalence of Outcomes Between Ambulatory and Hospital-Based Arthroplasty in Younger and Older Adults. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.014
A retrospective propensity-matched cohort of 10,804 elective primary hip and knee arthroplasties at one academic health system compared 90-day outcomes between ambulatory surgery centers and hospitals, stratified by age (<75 vs. ≥75 years). ASC patients had shorter stays, shorter operative times, and more home discharges, with no significant differences in complications among patients ≥75. These findings support the safety of ASC-based arthroplasty even for older adults.
116. Lam AD, Parikh N, Valenzuela M, et al. More Tech-Savvy Than You Think: Digital Proficiency Among Total Joint Arthroplasty Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.033
A prospective survey of 201 total joint arthroplasty patients using the Mobile Device Proficiency Questionnaire compared digital skills between patients under and over age 65. Daily smartphone use was nearly universal in both groups (80% even among those ≥65), with similar ease navigating menus, typing, and emailing across age groups. Elderly TJA patients are more digitally capable than commonly assumed, supporting the use of smartphone-based platforms for patient-reported outcome collection and perioperative data capture in this population.
117. Ren BO, Zhu Q, Kim MHSA T, et al. Patient-Reported Outcomes Measures Collection Method by Timeframe: Different Strategies for Different Times. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.038
This retrospective review of a regional arthroplasty registry evaluated PROM collection methods and response rates for HOOS/KOOS JR and PROMIS-10 at preoperative, early postoperative, and one-year timepoints, with 18,602 of 71,672 cases completing all surveys. Completion of all three surveys was more likely in women, never smokers, and patients treated at hospitals or outpatient settings. The findings suggest that different collection strategies may be needed at different timeframes to improve response rates and meet CMS reporting requirements.
125. Haji Boloori F, Kubiak A, Meyers M, et al. Temporal Trends in Surgical Site Infections After Hip and Knee Arthroplasty in California, 2015 to 2024. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.028
This longitudinal cohort study analyzed California's mandatory SSI surveillance data for primary THA and TKA from 2015 to 2024, comprising 5,880 hospital-year-procedure observations. Generalized linear models assessed whether hospital volume, policy epochs, and the COVID-19 pandemic were associated with SSI risk over time. The results clarify the population-level effectiveness of a decade of mandatory SSI reporting on arthroplasty infection rates.
Other articles this month¶
2. Hoit G, Dwyer T, Chahal J, et al. The Incidence and Breadth of Postoperative Pudendal Nerve Palsy and Its Relationship to Table Traction During Hip Arthroscopy With a Perineal Post. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261485701
This cohort study of 93 patients undergoing primary unilateral supine hip arthroscopy with a perineal post used a traction-force sensor and serial confidential questionnaires (including validated sexual function instruments) to characterize postoperative pudendal nerve palsy through 12 months. It defined the incidence, anatomic breadth, and duration of pudendal symptoms and their relationship to traction duration and force. The results inform preoperative consent regarding pudendal nerve palsy risk and may guide intraoperative traction management.
7. Huttner JR, Hu E, Henriques M, et al. Improved Outcomes in Hip Abductor Tendon Repairs With Augmentation and Gluteus Maximus Transfer: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70604
This systematic review (6 studies, 261 patients) synthesized outcomes of surgical repair of symptomatic hip abductor tendon tears augmented with graft augmentation or gluteus maximus transfer. Repairs showed consistent improvements in pain (VAS reductions of ~3.5-6.6) and function (mHHS gains of ~21-44; HOS-ADL gains of ~24-34), though only a minority of studies reported minimal clinically important difference or patient acceptable symptom state data. Augmented abductor repair appears effective, but more patient-level clinically meaningful outcome reporting is needed.
8. ipek E, Altuntaş Y, Balkanlı B, et al. Identification of patient subgroups by hierarchical cluster analysis in femoral neck fractures and surgical outcome analysis. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06487-x
This study applied hierarchical cluster analysis to femoral neck fracture patients to identify multidimensional clinical subgroups beyond single-variable classification, then compared mortality, postoperative mobility, and complications between clusters. It demonstrated that data-driven subgrouping captures heterogeneity in patient profiles affecting surgical outcomes. Such clustering could refine risk stratification and individualize treatment and follow-up strategies for femoral neck fractures.
10. Unknown Author. Announcements. Arthroscopy 2026. doi:10.1002/arj.70675
This announcement describes AANA educational offerings, including unlimited 2026 Learning Center access, October 24 hands-on cadaver lab courses in hip arthroscopy and complicated knee management, and the AANA27 meeting in Hollywood, Florida, May 13-15, 2027. No research findings are reported. The clinical implication is limited to encouraging surgeons to pursue skills training and continuing education opportunities.
16. Beyer RSH, Nitz JN, Dhawan A, et al. Short‐Term Clinical and Patient‐Reported Outcomes Are Similar for Neuraxial Compared With General Anesthesia for Hip Arthroscopy. Arthroscopy 2026. doi:10.1002/arj.70603
This retrospective registry study of 159 hips compared neuraxial versus general anaesthesia for hip arthroscopy for femoroacetabular impingement, assessing complications, revision/conversion rates, patient-reported outcomes, and operative times at 2 years. Short-term clinical and patient-reported outcomes were similar between anaesthetic types. Anaesthesia choice can therefore be individualized based on patient factors without compromising outcomes.
18. Mastrokostas PG, Mastrokostas LE, Klein B, et al. Increasing Utilization, Rising Facility Charges, and Evolving Procedure Mix in Hip Arthroscopy at United States Hospital‐Based Ambulatory Surgical Centers From 2016 to 2022. Arthroscopy 2026. doi:10.1002/arj.70609
Using the HCUP National Ambulatory Surgery Sample, this study analyzed 141,870 weighted hip arthroscopy encounters in US hospital-based ambulatory surgical centers from 2016 to 2022. Femoroplasty and labral repair volumes rose steadily, with increasing facility charges and shifting procedure mix, alongside regional and payer variation. The findings indicate hip arthroscopy is migrating increasingly to the ASC setting with growing cost implications for payers and health systems.
25. Kodra JD, Girardi KG, Marinelli S, et al. Supine Versus Standing Pelvic Radiographs Yield Significantly Different Radiographic Parameters in Femoroacetabular Impingement and Hip Dysplasia: A Systematic Review and Meta‐analysis. Arthroscopy 2026. doi:10.1002/arj.70547
This systematic review and meta-analysis of 12 studies (824 hips) compared radiographic parameters on supine versus standing pelvic radiographs in patients with FAI and acetabular dysplasia. Standing radiographs yielded significantly different measurements of LCEA, Tönnis angle, and pelvic tilt compared with supine films. Clinicians should recognize that weight-bearing positioning alters these parameters and may influence surgical planning for hip preservation procedures.
29. Jiang X, Lin D, Huang Y, et al. A comparative study on the clinical efficacy and complications of proximal femoral nail antirotation and femoral neck system in the treatment of basicervical femoral neck fracture (AO/OTA 31-B3). Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06382-5
This retrospective study of 99 patients compared the femoral neck system (FNS, n=53) versus proximal femoral nail antirotation (PFNA, n=46) for basicervical femoral neck fractures (AO/OTA 31-B3). Reduction quality, tip-apex distance, operative time, and fixation-related complications were compared between implants. The findings inform implant selection for these unstable fractures, where fixation failure risk is inherently high.
35. Yoshitani J, Dulleston J, Rafati Fard AR, et al. Association between preoperative radiographic osteoarthritis severity and patient-reported outcomes after total hip arthroplasty: a systematic review and meta-analysis. International Orthopaedics 2026. doi:10.1007/s00264-026-07000-0
This systematic review and meta-analysis of 18 observational studies (9,235 patients) examined whether preoperative radiographic osteoarthritis severity influences patient-reported outcomes after total hip arthroplasty. Severe radiographic osteoarthritis was associated with modestly better postoperative function and health-related quality of life than moderate disease, though with substantial heterogeneity and small effect sizes. Clinically, radiographic severity alone should not be used to delay surgery, as the differences are small and other patient factors likely dominate outcome variability.
36. Chi J, Liu C, Lo Y, et al. Superior reduction quality without improved outcomes: open versus closed reduction for displaced femoral neck fractures in adults under 60 years. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06475-1
This retrospective comparative study evaluated open versus closed reduction for displaced femoral neck fractures in adults under 60 years, analyzing reduction quality, femoral neck shortening, and complications. Open reduction achieved a higher rate of excellent radiographic reduction but did not reduce complication rates compared with closed reduction, with fracture severity, age, and reduction quality emerging as the principal outcome determinants. The results support a fracture morphology-guided approach to fixation rather than routine open reduction, along with realistic patient counseling.
42. Sparks CA, Brinkman JC, Monty TL, et al. Labral Repair With Concomitant Endoscopic Gluteus Medius and/or Minimus Repair: Outcomes at a Minimum 5-Year Follow-up Relative to a Propensity Score–Matched Control Group. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261479917
In this retrospective propensity score-matched cohort study, patients undergoing concomitant endoscopic gluteal tendon and labral repair were compared with isolated labral repair at a minimum 5-year follow-up using patient-reported outcomes and reoperation-free survival. The study addresses the gap in mid-term evidence for combined gluteal and labral procedures. Findings inform surgical decision-making when gluteal and labral tears coexist.
45. Elsheikh R, Amsler F, Brand C, et al. Not all previous surgeries are the same: Procedure‐specific infection risk in total knee arthroplasty patients with a history of previous knee surgery. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70599
Using Swiss implant registry data on 121,692 primary total knee arthroplasties, this study assessed revision for infection according to the specific type of prior ipsilateral knee surgery rather than treating all previous procedures as a uniform risk factor. Procedure-specific infection risks varied substantially across prior surgery types, with cumulative surgical burden also influencing risk. Preoperative risk stratification and counseling should be tailored to the specific history of prior knee procedures.
46. Patel RM, Selley RS, Baker HP, et al. The Femoral Impingement Index Predicts Inferior Clinical Outcomes in Men Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthroscopy 2026. doi:10.1002/arj.70525
This registry-based study of 456 hips examined whether CT-based femoral version, McKibbin index, and femoral impingement index (FII) predicted outcomes after hip arthroscopy for femoroacetabular impingement syndrome. While femoral version and McKibbin index showed no association with outcomes, a high FII predicted inferior patient-reported outcomes in men. The FII may help identify male patients at risk for suboptimal results and guide preoperative planning.
47. McMillan S, Ford E. Arthroscopic Hip Capsule Closure Augmented With a Nonwoven Polyethylene Terephthalate Scaffolding. Arthroscopy Techniques 2026. doi:10.1002/atn2.70254
This technical note describes an arthroscopic hip capsule closure technique augmented with a nonwoven polyethylene terephthalate scaffold secured via a felting-needle mechanism. The method provides strong time-zero mechanical augmentation to capsular repair, addressing deficient tissue quality and technical difficulty that contribute to closure failure. It offers surgeons a practical option for improving capsule closure after hip arthroscopy.
49. Enocson A, Lundin A, Granqvist M. Pelvic injuries in elderly trauma patients: epidemiology, injury characteristics, in-hospital care and factors influencing mortality. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06506-x
This Swedish national registry study analyzed 11,624 trauma-alert patients aged ≥60 years (2022-2024) to identify factors influencing 30-day mortality, with multivariable regression adjusting for gender, ASA class, NISS, and head injury. Pelvic injuries occurred in 6.7% of patients and were associated with higher-energy trauma and greater injury severity (median NISS 17 vs. 11). The findings help clarify whether pelvic fractures independently drive mortality in elderly trauma and inform triage, in-hospital care, and discharge planning for this growing population.
53. Güzel N, Genç AS, Gümüş NE, et al. Pain, quality of life, and functional outcomes of total hip arthroplasty in female patients with crowe type III–IV developmental dysplasia of hip: retrospective cohort study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06504-z
This retrospective cohort study of 45 female patients aged 32-65 with Crowe type III, IV developmental dysplasia of the hip evaluated pain, quality of life, and functional outcomes after total hip arthroplasty with subtrochanteric shortening osteotomy, using pre- and postoperative measures including the 30-second chair-stand test, 6-minute walk test, VAS, HHS, EQ-5D-5L, FJS-12, HOOS, and SF-36. At mid-term (≥2-year) follow-up, significant improvements were seen in physical performance measures and patient-reported pain, function, and quality-of-life scores. The findings confirm substantial physical and psychosocial recovery after THA in this complex high-dislocation dysplasia population.
54. Kodra JD, Schweinert A, Memon AA, et al. Revision and complication rates after total joint arthroplasty in patients with monoclonal gammopathy of undetermined significance and multiple myeloma. International Orthopaedics 2026. doi:10.1007/s00264-026-07024-6
This retrospective single-center study of 68 patients (43 with multiple myeloma, 25 with MGUS) who underwent primary hip or knee total joint arthroplasty between 2005 and 2023 characterized complications and implant survivorship using competing-risk models. Overall, 27.9% experienced at least one postoperative complication and 25.0% required revision, with revision risk not significantly different between MM and MGUS patients (sHR 1.49, P = 0.42). The results indicate that both conditions carry a notable complication burden after TJA, warranting heightened perioperative surveillance in these patients.
57. Hölmich P, Weir A, Papadopoulou T, et al. Hip and groin pain in physically active adults with a focus on terminology, clinical examination and imaging: A formal ESSKA‐EHPA‐ESMA Consensus. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70565
A formal ESSKA-EHPA-ESMA consensus process involving 57 multidisciplinary experts from 22 countries produced 13 graded statements on terminology, clinical examination, and imaging for hip and groin pain in physically active adults. Median agreement ratings ranged from 8 to 9 out of 9, with strong agreement on five questions. Clinicians can use these evidence- and expert-based recommendations to standardize the assessment and communication of hip and groin conditions in athletes.
58. Morris K, Öttl F, Pruneski JA, et al. Select large language models outperform hip preservation experts on consensus‐based hip preservation questionnaire. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70581
Three large language models (ChatGPT 5.2, Gemini 3, Claude 4.5 Sonnet) were tested against ten international hip preservation experts on a 21-item questionnaire covering femoroacetabular impingement, hip dysplasia, and hip microinstability. Select LLMs outperformed the expert panel in accuracy and agreement on guideline-based questions. This suggests AI tools may serve as reliable adjuncts for guideline-based information in hip preservation, though clinical oversight remains essential.
61. Gómez‐Verdejo F, Villarreal‐Espinosa JB, Vega TF, et al. Segmental and Circumferential Hip Labral Reconstructions Both Show Favorable Outcomes in Primary Hip Arthroscopy: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70450
A systematic review of 9 studies (371 hips) compared segmental versus circumferential hip labral reconstruction for irreparable labral tears in nondysplastic hips with minimum 24-month follow-up. Both techniques showed favourable and comparable postoperative outcome scores (modified Harris Hip Score and International Hip Outcome Tool-12 ranges overlapped substantially between techniques). Surgeons can expect good clinical results with either reconstruction approach, though the low quality and heterogeneity of available evidence limits definitive conclusions.
64. Lefèvre N, Moussa MK, Valentin E, et al. Structural Allograft Reconstruction for Chronic Proximal Hamstring Avulsion Yields Significant Functional Improvement, Acceptable Satisfaction, but Limited Return to Preinjury Sport Levels. Arthroscopy 2026. doi:10.1002/arj.70513
A retrospective cohort study of 42 patients (mean follow-up 3.4 years) evaluated structural allograft reconstruction for chronic proximal hamstring avulsion injuries, using the Parisian Hamstring Avulsion Score as the primary outcome. The PHAS improved significantly from a median of 56.3 preoperatively to 84.5 at final follow-up, exceeding the minimal clinically important difference, with acceptable satisfaction but limited return to preinjury sport levels. Allograft reconstruction is a reliable option for functional restoration in chronic proximal hamstring avulsions, though patients should be counseled that return to prior sport levels may not be achievable.
68. Henry A, Kang L, Smith J, et al. High Rates of Return to Soccer After Primary Hip Arthroscopic Labral Repair for Femoroacetabular Impingement Syndrome. Arthroscopy, Sports Medicine, and Rehabilitation 2026. doi:10.1002/ars2.70072
A retrospective review of 41 soccer players (48 hips) undergoing primary hip arthroscopic labral repair for femoroacetabular impingement assessed return to sport and patient-reported outcomes at ≥2 years. About 81% returned to soccer (78% at recreational/high school level), with returners showing significantly better postoperative Hip Outcome Score, ADL values. Arthroscopic labral repair offers a high likelihood of return to soccer, supporting shared decision-making for athletes.
71. Duan Y. PASS Thresholds and Denominators After Nonoperative Management of Femoroacetabular Impingement Syndrome: Letter to the Editor. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261461215
This letter to the editor critiques a study establishing Patient Acceptable Symptom State (PASS) thresholds after nonoperative management of femoroacetabular impingement, highlighting apparent data inconsistencies, particularly in the Hip Outcome Score, ADL subscale and patient denominators. The author calls for corrected reporting to ensure valid interpretation of treatment-specific PASS values. Clinicians should await clarification before applying these thresholds in nonoperative FAI care.
72. Hoit G, Whelan DB, Lemieux V, et al. PASS Thresholds and Denominators After Nonoperative Management of Femoroacetabular Impingement Syndrome: Response. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261464178
The authors respond to a letter critiquing their PASS threshold study after nonoperative femoroacetabular impingement management, acknowledging and correcting calculation errors in Table 2 for the number of patients achieving PASS on HOS-ADL and VAS at 6 months. They note these counts were not central to the study's conclusions but provide an updated table for accuracy. The exchange underscores the importance of accurate denominators when interpreting PASS achievement in clinical studies.
73. Unknown Author. Title Page (place for Supplements only). The Journal of Arthroplasty 2026. doi:10.1016/s0883-5403(26)00848-x
This is a title page for a proceedings issue of The Hip Society published in The Journal of Arthroplasty, supported by an educational grant from AAHKS. It describes the journal's double-anonymized peer-review process and conflict-of-interest policies for editorial leaders. No clinical findings are presented.
74. Kahana-Rojkind AH, Strok MJ, Walsh EG, et al. Factors Associated With Return to Sport at Minimum 10-Year Follow-up in Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261451218
This retrospective cohort study propensity-matched 50 athletes with borderline hip dysplasia undergoing primary hip arthroscopy with capsular plication to 53 controls with normal acetabular coverage, with minimum 10-year follow-up. Both groups showed similar patient-reported outcome improvements and return-to-sport rates. The findings support hip arthroscopy with capsular plication as a durable option for athletes with borderline dysplasia at long-term follow-up.
76. Yin X, Li Z, Zhu Y, et al. Association of thigh muscle status and longitudinal changes assessed by MRI with subsequent total hip arthroplasty: insights from the osteoarthritis initiative. Arthroplasty 2026. doi:10.1186/s42836-026-00423-5
Using the Osteoarthritis Initiative cohort, this study performed a year-2 landmark analysis matching 99 hips that underwent subsequent total hip arthroplasty to 396 controls, with thigh muscle cross-sectional areas quantified by U-Net MRI segmentation. Greater 2-year change in total thigh muscle CSA was associated with THA risk in Cox models. Thigh muscle MRI markers may help characterize progression risk in hip osteoarthritis, though the study did not develop a clinical prediction model.
79. Klein P, Hormi-Ménard M, Erivan R, et al. Can we trust the accuracy of the automatic calibration of the EOS system to measure lower limb length inequality after total hip arthroplasty? Comparison of EOS versus manual measurement on 110 calibrated radiographs. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2024.104079
This method-comparison study evaluated 110 post-THA radiographs, comparing EOS automatic calibration against manual calibration for measuring lower limb length inequality, with two blinded readers analyzing DICOM and uncalibrated JPEG files. The authors assessed whether automatic EOS calibration is accurate and reproducible versus the conventional manual method. The results inform whether manual calibration remains necessary for LLLI assessment after THA.
92. Bonte C, Van Quickenborne D, Audenaert E, et al. Surgical augmentation of gluteal tendon tears: a systematic review of techniques, indications and comparative clinical outcomes. EFORT Open Reviews 2026. doi:10.1530/eor-2025-0003
This systematic review examined surgical augmentation techniques for gluteal tendon tears, summarizing indications, operative methods, and comparative clinical outcomes across published studies. It maps the current evidence base for augmenting hip abductor tendon repairs. Clinically, it guides surgeons in selecting augmentation strategies and highlights gaps in comparative outcome data.
119. Pullen WM, Pierre KJ, Simunovic N, et al. Interobserver Reliabilities of 2 Classifications for Arthroscopic Classification of the Pulvinar Tissue. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261444305
Nine experienced hip preservation surgeons graded 300 intraoperative arthroscopic photographs of the acetabular pulvinar using a 6-option descriptive system and a 4-point Likert synovitis system to assess interobserver reliability. The study was powered to provide 95% confidence intervals with a defined margin of error for reliability estimates. Establishing the reliability of these grading systems is a prerequisite for future studies investigating the clinical significance of pulvinar pathology in hip arthroscopy.
121. Solla F, Roussouly P. Comments on: “An archetypal analysis of lumbopelvic profiles could help predict adverse spinopelvic mobility after total hip arthroplasty” by Aubert T, Hallé A, Aubert O, published in Orthop Traumatol Surg Res. 2026: 104662. doi: 10.1016/j.otsr.2026.104662. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104903
Solla and Roussouly comment on Aubert et al.'s archetypal analysis of lumbopelvic profiles for predicting adverse spinopelvic mobility after total hip arthroplasty. They discuss the strengths and limitations of using archetypal analysis to classify spinopelvic mobility patterns in this context. The commentary underscores the value of Roussouly's spinopelvic classification framework for preoperative planning in hip arthroplasty.
122. Khoury P, Vellala S, McCurdy MA, et al. Association of Preoperative Opioid Use and Smoking With Opioid Refill After Hip Arthroscopy. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261472200
This case-control study examined risk factors for opioid refill within 3 months of hip arthroscopy for femoroacetabular impingement syndrome or labral tear using an orthopaedic registry. Preoperative opioid use and smoking were evaluated as predictors of postoperative opioid refill. The findings inform preoperative counseling and opioid stewardship strategies in hip arthroscopy patients.
126. Shankar DS, Collins AP, Sugumaran S, et al. Comparison of Clinical Outcomes After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Running Athletes Versus Nonrunners. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261485754
This level 2 cohort study compared minimum 2-year patient-reported outcomes after primary hip arthroscopy for femoroacetabular impingement syndrome between running athletes and nonrunners using HOOS subscale scores. Multivariable regression adjusted for age and other covariates to determine whether runner status independently predicted postoperative outcomes. The findings help counsel runners regarding expected outcomes and return to activity after hip arthroscopy.