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Clinical Updates on Knee and Hip Arthroplasty
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Clinical Updates on Knee and Hip Arthroplasty

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (31 December 2025) | Viewed by 8297

Special Issue Editors

Dr. Amarildo Smakaj

E-Mail Website
Guest Editor
1. Department of Biomedicine and Prevention, “Tor Vergata” University of Rome, 00133 Rome, Italy
2. Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy
Interests: acetabulum fracture; internal fixation; pelvis; hip arthroplasty; knee arthroplasty; revision hip arthroplasty
Prof. Dr. Elena Gasbarra

E-Mail Website
Guest Editor
1. Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
2. Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 81, 00133 Rome, Italy
Interests: orthopedics; traumatology; prosthetic hip and knee surgery

Special Issue Information

Dear Colleagues,

Knee and hip arthroplasty remains the most effective intervention for patients with advanced osteoarthritis or joint trauma. This procedure provides significant pain relief, improves mobility, and enhances the quality of life for millions of individuals worldwide. However, as the number of patients requiring knee and hip arthroplasty continues to rise, so too does the need for continuous updates on clinical practices, innovations, and challenges in these areas.

This Special Issue, “Clinical Updates on Knee and Hip Arthroplasty”, aims to present a comprehensive overview of the latest developments in the field, highlighting both advances in surgical techniques and emerging challenges that clinicians face. The issue will explore a range of topics critical to optimising patient outcomes, including the following:

  • Advancements in Surgical Techniques: The refinement of minimally invasive procedures, navigation systems, and robotic-assisted surgeries has transformed knee and hip arthroplasty. This section will delve into how these innovations are improving accuracy, reducing recovery times, and minimizing complications.
  • Implant Materials and Longevity: Research continues to explore new biomaterials and designs that enhance the durability of implants, reducing the need for revision surgeries. This topic will cover the latest advancements in implant technology, including the use of novel coatings and materials for improving joint stability and longevity.
  • Postoperative Rehabilitation and Pain Management: Successful recovery after arthroplasty is heavily dependent on effective rehabilitation and pain management strategies. This section will focus on multidisciplinary approaches to postoperative care, with an emphasis on early mobilization, non-opioid pain control, and patient education.
  • Complications and Revision Surgery: Although the majority of knee and hip arthroplasty surgeries are successful, complications such as infection, implant loosening, or dislocation remain concerns. The issue will address current best practices for preventing, diagnosing, and treating complications, as well as advances in revision surgery techniques.

By bringing together the latest evidence and expert insights, this Special Issue will provide a valuable resource for orthopedic surgeons, rehabilitation specialists, and healthcare professionals involved in the care of knee and hip arthroplasty patients. The goal is to foster a deeper understanding of both the opportunities and challenges in contemporary joint replacement practice, ultimately improving patient outcomes and the quality of care in this rapidly evolving field.

Dr. Amarildo Smakaj
Prof. Dr. Elena Gasbarra
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • knee arthroplasty
  • hip arthroplasty
  • total joint replacement
  • minimally invasive arthroplasty
  • implant durability
  • postoperative rehabilitation
  • revision arthroplasty
  • prosthesis-related complications
  • periprosthetic joint infection
  • implant loosening

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Research

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10 pages, 555 KB  
Article
Does Patellar Resurfacing Improve Outcomes in Valgus Osteoarthritis with Compromised Patellofemoral Joint Status? A Retrospective Consecutive Comparative Study
by Jae-Sung Seo, Jung-Kwon Bae, Seong-Kee Shin, Hyung-Gon Ryu, Kyu-Jin Kim and Ji Seon Chae
J. Clin. Med. 2026, 15(4), 1587; https://doi.org/10.3390/jcm15041587 - 18 Feb 2026
Viewed by 301
Abstract
Background/Objectives: The benefit of patellar resurfacing (PR) in total knee arthroplasty (TKA) remains controversial. No previous study has examined the impact of PR in valgus osteoarthritis (OA) with compromised patellofemoral joint (PFJ) status. Methods: We retrospectively reviewed 2250 primary TKAs performed [...] Read more.
Background/Objectives: The benefit of patellar resurfacing (PR) in total knee arthroplasty (TKA) remains controversial. No previous study has examined the impact of PR in valgus osteoarthritis (OA) with compromised patellofemoral joint (PFJ) status. Methods: We retrospectively reviewed 2250 primary TKAs performed between 2011 and 2025. Among 152 valgus OA cases, 87 had compromised PFJ status, defined as Outerbridge grade 3–4 chondral damage or patellar tilt >10° on Merchant-view radiographs. Two surgeons with identical protocols operated during overlapping periods; one typically performed PR (n = 47) and the other did not (n = 40). Primary outcomes included the American Knee Society (AKS) score and Kujala Anterior Knee Pain Scale. Secondary outcomes included radiologic measures (HKA angle, patellar tilt, and lateral patella shift) and patellar-related complications (crepitus, fracture, subluxation, and maltracking). Results: At a mean follow-up of 7.1 years in the non-PR group and 6.5 years in the PR group, no significant differences were observed between groups in KSS function scores (non-PR 92.4 ± 3.5 vs. PR 93.0 ± 4.6, p = 0.54) or Kujala scores (non-PR 76.9 ± 3.5 vs. PR 77.7 ± 4.2, p = 0.33). Both patellar tilt and lateral patella shift showed slight postoperative reductions, but no significant difference was observed between groups (patellar tilt: non-PR 5.4° ± 0.8° vs. PR 5.7° ± 0.6°, p = 0.11; lateral patella shift: non-PR 2.4 ± 0.6 mm vs. PR 2.3 ± 0.7 mm, p = 0.75). Patellar-related complications were infrequent and showed no significant differences. Conclusions: Overall, PR did not demonstrate superior outcomes compared with non-PR in valgus OA patients with compromised PFJ status at mid-term follow-up. Full article
(This article belongs to the Special Issue Clinical Updates on Knee and Hip Arthroplasty)
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9 pages, 589 KB  
Article
The Impact of Femoral Anteversion Correction on Clinical Outcomes in Total Hip Arthroplasty for Adult Developmental Dysplasia of the Hip
by Ahmet Burak Satılmış, Tolgahan Cengiz, Ahmet Ülker and Tansel Mutlu
J. Clin. Med. 2025, 14(9), 3207; https://doi.org/10.3390/jcm14093207 - 6 May 2025
Cited by 5 | Viewed by 2127
Abstract
Background: Total hip arthroplasty (THA) in adult patients with developmental dysplasia of the hip (DDH) presents unique surgical challenges due to altered hip anatomy and biomechanics. One of the most critical factors influencing surgical success is correcting femoral anteversion. This study evaluates the [...] Read more.
Background: Total hip arthroplasty (THA) in adult patients with developmental dysplasia of the hip (DDH) presents unique surgical challenges due to altered hip anatomy and biomechanics. One of the most critical factors influencing surgical success is correcting femoral anteversion. This study evaluates the effects of different anteversion corrections (increased, unchanged, and decreased) during THA on clinical outcomes in adult Crowe type 3-4 DDH patients. Methods: A retrospective analysis was conducted on 130 patients who underwent THA with anteversion correction between 2008 and 2017 at a tertiary university hospital. Patients were divided into three groups: Group 1 (increased anteversion), Group 2 (unchanged anteversion), and Group 3 (decreased anteversion). Clinical outcomes were assessed using AOFAS and Lysholm scores, Q-angle measurements, and physical examinations, while radiological evaluations were performed to determine implant stability and complications. Results: Postoperative assessments show that increased anteversion is associated with higher rates of instability, knee dysfunction, and pain. Group 1 had significantly lower AOFAS scores (p < 0.001) and fell due to rotational deformity (25.6%). Group 2 exhibited the best clinical outcomes, with the lowest rates of instability and the highest functional scores. Group 3 had moderate functional improvements but a higher dislocation rate (17.1%) than Group 2. Conclusions: Our findings suggest that excessive changes in femoral anteversion during THA, remarkably increasing it, may negatively impact clinical outcomes by causing instability and pain. Preserving the anteversion angle as much as possible is the most favorable approach for optimizing functional recovery and implant stability. Further large-scale, long-term studies are required to confirm these findings and refine surgical strategies for DDH patients undergoing THA. Full article
(This article belongs to the Special Issue Clinical Updates on Knee and Hip Arthroplasty)
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16 pages, 703 KB  
Article
Physiotherapists’ Experiences with the Hip Disability and Knee Injury Osteoarthritis Outcome Score Following Total Hip and Knee Arthroplasty: A Qualitative Interview Study
by Dennis J. van den Berg, Esther T. Maas, Rosa-Lynn Edelaar, Mathijs B. Arendsen, Elizabeth J. de Louw, Henri Kiers, Thea P. M. Vliet Vlieland, Raymond W. J. G. Ostelo and Marianne H. Donker
J. Clin. Med. 2025, 14(3), 992; https://doi.org/10.3390/jcm14030992 - 4 Feb 2025
Viewed by 1758
Abstract
Background: Clinical guidelines for physiotherapy following total hip and knee arthroplasty (THA/TKA) recommend using Patient-Reported Outcome Measures (PROMs) like the Hip disability and Knee injury Osteoarthritis Outcome Score (HOOS/KOOS). However, it remains unclear how physiotherapists use these PROMs in daily clinical practice. Objective: [...] Read more.
Background: Clinical guidelines for physiotherapy following total hip and knee arthroplasty (THA/TKA) recommend using Patient-Reported Outcome Measures (PROMs) like the Hip disability and Knee injury Osteoarthritis Outcome Score (HOOS/KOOS). However, it remains unclear how physiotherapists use these PROMs in daily clinical practice. Objective: To explore primary care physiotherapists’ experiences with the HOOS/KOOS in daily clinical practice following THA and TKA. Methods: Thirteen physiotherapists in the Netherlands were recruited via convenience sampling. Data were collected through semi-structured interviews, which explored HOOS/KOOS use in clinical practice, administrative regulations, and applications beyond patient care, as well as think-aloud interviews to capture perceptions of the content of these PROMs and interpretations of hypothetical patient scores. Interviews were analysed using reflexive thematic analysis. Results: The physiotherapists’ ages ranged from 25 to 54y, with annual THA/TKA volumes from 5 to 50 patients. Three themes emerged, as follows: (1) “Physiotherapists use the HOOS/KOOS for various purposes in daily clinical practice”, including complementing history taking and monitoring patient progress; (2) “Perceptions of the relevance of the HOOS/KOOS for daily clinical practice vary per item, domain, and version,” with items related to daily life activities and psychosocial factors being perceived as more valuable; and (3) “Practical aspects of HOOS/KOOS administration influence their use in daily clinical practice,” with electronic health records (EHRs) that facilitate PROM administration enhancing their use, while administrative regulations limit this. Conclusions: Physiotherapists experience HOOS/KOOS items related to daily life activities and psychosocial factors useful for history-taking and monitoring patient progress, particularly when embedded in EHRs that facilitate PROM administration. Full article
(This article belongs to the Special Issue Clinical Updates on Knee and Hip Arthroplasty)
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Review

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17 pages, 1254 KB  
Review
A Nerve Injury After Total Hip Arthroplasty from Etiology to Treatment: A Narrative Review
by Alberto Di Martino, Matteo Brunello, Isabella Giannini, Manuele Morandi Guaitoli, Chiara Di Censo, Federico Pilla and Cesare Faldini
J. Clin. Med. 2026, 15(2), 563; https://doi.org/10.3390/jcm15020563 - 10 Jan 2026
Viewed by 2571
Abstract
Total hip arthroplasty (THA) is a widely performed procedure that significantly enhances patients’ quality of life. However, nerve injury remains a concerning complication, with an incidence ranging from 0.6% to 3.7%, depending on patient and surgical variables. This narrative review provides a comprehensive [...] Read more.
Total hip arthroplasty (THA) is a widely performed procedure that significantly enhances patients’ quality of life. However, nerve injury remains a concerning complication, with an incidence ranging from 0.6% to 3.7%, depending on patient and surgical variables. This narrative review provides a comprehensive overview of nerve injuries associated with THA, focusing on etiology, risk factors, clinical manifestations, prevention, and treatment strategies. The most affected nerves include the sciatic, femoral, lateral femoral cutaneous (LFCN), superior gluteal, and obturator nerves. Anatomical factors such as developmental hip dysplasia (DDH), limb length discrepancy, and aberrant nerve courses, along with patient-specific conditions like female sex, obesity, and pre-existing spinal disorders, increase the risk of nerve damage. Surgical complexity, revision procedures, and surgeon experience also influence injury likelihood. Clinical manifestations range from sensory disturbances to motor deficits including foot drop, Trendelenburg gait, or impaired knee extension, depending on the nerve involved. Diagnosis is primarily clinical, supported by electrophysiological studies and imaging when needed. Prevention hinges on careful preoperative planning, appropriate surgical approach selection, meticulous intraoperative technique, and attention to limb positioning. Treatment is typically conservative, involving pain control, physical therapy, and neurostimulation. In refractory or severe cases, interventions such as nerve decompression, repair, or tendon transfer may be considered. Pharmacological agents including vitamin B12, tacrolimus, and melatonin show potential in promoting nerve regeneration. Although most nerve injuries resolve spontaneously or with conservative measures, some cases may result in long-term deficits. Understanding the mechanisms, risk factors, and management strategies is essential to mitigating complications and optimizing functional outcomes in patients undergoing THA. Full article
(This article belongs to the Special Issue Clinical Updates on Knee and Hip Arthroplasty)
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Other

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16 pages, 1966 KB  
Systematic Review
The Impact of Surgical Approach on Mid-Term Clinical Outcomes Following Hemiarthroplasty for Femoral Neck Fractures: A Systematic Review and Meta-Analysis of Postero-Lateral Versus Direct Lateral Approaches
by Gianmarco Marcello, Francesco Rosario Parisi, Lorenzo Alirio Diaz Balzani, Alessandro Del Monaco, Emanuele Zappalà, Giuseppe Francesco Papalia, Chiara Capperucci, Erika Albo, Augusto Ferrini, Biagio Zampogna and Rocco Papalia
J. Clin. Med. 2025, 14(24), 8846; https://doi.org/10.3390/jcm14248846 - 14 Dec 2025
Viewed by 681
Abstract
Background: Femoral neck fractures in the elderly often necessitate hemiarthroplasty, but the optimal surgical approach remains a highly debated topic. The postero-lateral and direct lateral approaches are commonly employed, each with benefits and drawbacks. Despite their widespread use, robust, long-term comparative studies [...] Read more.
Background: Femoral neck fractures in the elderly often necessitate hemiarthroplasty, but the optimal surgical approach remains a highly debated topic. The postero-lateral and direct lateral approaches are commonly employed, each with benefits and drawbacks. Despite their widespread use, robust, long-term comparative studies on definitive outcomes, including pain, functional recovery, and complication rates, are notably lacking. This systematic review and meta-analysis aim to address this critical gap by meticulously comparing these approaches with long-term follow-up. Methods: A systematic literature search was performed, including only comparative studies with a minimum 1-year follow-up. A meta-analysis was performed for the primary outcome measures: operative time, dislocations, infections, perioperative fractures and reoperations. Secondary outcomes included a qualitative synthesis of patient-reported outcomes (quality of life, pain, and satisfaction). Methodological quality was assessed using RoB 2.0 for randomized controlled trials and MINORS criteria for cohort studies. Results: Our meta-analysis provides robust quantitative evidence. The direct lateral approach is associated with a significantly lower risk of post-operative dislocations (I2 = 58%; OR = 2.86, 95% CI: 2.53 to 3.22; p < 0.00001) and a significantly lower rate of reoperation (I2 = 0%; OR = 1.25, 95% CI: 1.12 to 1.40; p = 0.0001) compared to postero-lateral approach. Operative time, infection, and perioperative fracture rates were found to be statistically comparable. However, patient-reported outcomes yielded inconsistent results across studies, often becoming non-significant after adjusting for confounders. Conclusions: This meta-analysis shows that the direct lateral approach is associated with lower rates of dislocation and reoperation compared with the postero-lateral approach, while patient-reported outcomes remain variable across studies. Further high-quality comparative trials are needed to confirm these associations and guide surgical decision-making. Full article
(This article belongs to the Special Issue Clinical Updates on Knee and Hip Arthroplasty)
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