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Hip and Knee Replacement: Clinical Advances and Current Challenges

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

Deadline for manuscript submissions: closed (14 March 2025) | Viewed by 7244

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Special Issue Editors

Prof. Dr. Lucian Bogdan Solomon

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Guest Editor

1. Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
2. Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
Interests: hip and knee reconstruction; joint replacement; orthopaedic trauma

Dr. Stuart Callary

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Guest Editor

1. Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
2. Centre for Orthopaedic and Trauma Research, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
Interests: hip replacement; musculoskeletal imaging; orthopaedic and trauma

Special Issue Information

Dear Colleagues,

Total hip and knee arthroplasty are recognised as successful and a cost-effective interventions for degenerative disease, especially osteoarthritis. The most common reasons for revision surgery are implant loosening, fracture, dislocation and infection. Imaging outcomes are used to assess and diagnose the common failure mechanisms. Radiographic imaging techniques including computed tomography (CT), magnetic resonance imaging, and plain X-rays have all been used to monitor implant survivorship following hip and knee arthroplasty. For example, monitoring early implant stability and wear are established surrogate methods to predict long-term success of new implant designs and surgical techniques. Manual measurement techniques have been digitised over time, and a number of specific software tools have been developed to improve the accuracy of implant measurements including radiostereometric analysis (RSA), Ein Build Roentgen Analyse (EBRA), PolyWare, Martells Hip Analysis Suite and ROMAN. The use of CT methods has increased as developments in image acquisition and software reconstruction continuously evolve to improve diagnostic capabilities. More recently, new semi-automated radiographic measurement methods have been introduced incorporating machine learning techniques and reducing observer error. This Special Issue will provide an overview of the current advances in orthopaedic implant imaging outcomes. We believe this Issue will be a valuable resource for clinicians and researchers looking to apply the latest imaging outcome measures to their clinical studies.

Prof. Dr. Lucian Bogdan Solomon
Dr. Stuart Callary
Guest Editors

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Keywords

hip and knee arthroplasty
implant
migration
wear
inducible displacement
radiostereometric analysis
computed tomography
magnetic resonance imaging

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Published Papers (8 papers)

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11 pages, 1384 KiB

Open AccessArticle

Impact of Prior Periacetabular Osteotomy on Total Hip Arthroplasty Outcomes in Patients with Developmental Dysplasia of the Hip

by Adam Czwojdziński, Jakub Leśniak, Andrzej Sionek, Dariusz Grzelecki and Jarosław Czubak

J. Clin. Med. 2025, 14(11), 3661; https://doi.org/10.3390/jcm14113661 - 23 May 2025

Viewed by 177

Abstract

Background: This study aims to demonstrate the challenges during the treatment of patients with osteoarthritis due to the development of dysplasia, which can be faced by surgeons who treat patients with THA. Our objective is to present our findings from a comparison of patients who underwent total hip arthroplasty (THA) for osteoarthritis secondary to developmental dysplasia of the hip (DDH), with or without a prior periacetabular osteotomy (PAO). Methods: We divided patients into two groups. Group A was adolescents who underwent periacetabular osteotomy and further THA in the orthopedic center (29 hips), and Group B was adolescents who underwent THA without PAO but suffered from DDH (24 hips). We measured blood loss, cup size, cup positioning, cup coverage, inclination and anteversion of the cup, duration of surgery, clinical scores, time of hospitalization, and the presence of ossification. Results: The mHHS score demonstrated significant differences (group A: 89 points vs. group B: 91 points; p = 0.03). The blood loss was expressed in the difference in Hb concentration preoperatively and on the 3rd postoperative day, which was higher by 0.85 mg/dL in group A (group A: 4.4 mg/dl vs. group B: 3.55 mg/dL; p = 0.004). Also, the value of HCT on the 3rd postoperative day was significantly lower in group A (group A: 27% vs. group B: 29.5%; p = 0.02). Radiological measurements showed a statistically significant difference in the Brooker scale (p = 0.005). Thirteen patients from group A after THA expressed first-grade ossifications or higher, and two patients from group B had first- and second-grade ossifications. Furthermore, a notably larger distalization was observed after the PAO procedure compared to those who underwent the procedure without PAO previously (79 mm [IQR = 73–83 mm] vs. 74.5 mm [IQR = 69–77 mm]; p = 0.004). Conclusions: Patients reported lower mHHS results, a higher risk of heterotopic ossifications, prosthesis head distalization, and more significant blood loss during the perioperative period after THA in patients who underwent PAO compared to those without a previously performed osteotomy. Full article

(This article belongs to the Special Issue Hip and Knee Replacement: Clinical Advances and Current Challenges)

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10 pages, 1872 KiB

Open AccessArticle

The Usefulness of the Lateral Femoral Epicondyle as a Landmark for Evaluating Leg Length Discrepancy in Robot-Assisted Total Hip Arthroplasty

by Dongnyoung Lee, Changhyun Nam, Jihoon Baek, Suchan Lee, Suengryol Ryu, Taehyeon Kim and Jihyo Hwang

J. Clin. Med. 2025, 14(9), 2905; https://doi.org/10.3390/jcm14092905 - 23 Apr 2025

Viewed by 297

Abstract

Objective: One of the biggest advantages of robot-assisted hip replacement surgery is the reduction in dislocation rates because of proper implant positioning and accurate measurement of the leg length. Therefore, we aimed to investigate the usefulness of using the lateral epicondyle as a landmark to minimize errors in leg length measurement. Methods: This retrospective study was conducted between September 2023 and March 2025 and included 24 patients who underwent robotic-assisted total hip arthroplasty (rTHA, Group I). These procedures were performed by two experienced surgeons. The data were compared with results from two additional groups: patients who underwent rTHA using the intrapatella landmark (Group II) and those who underwent conventional total hip arthroplasty (cTHA) without robotic assistance (Group III). Leg length measurements were evaluated using postoperative X-rays and intraoperative robotic monitoring. ANOVA and Student’s t-test were used to analyze the significance of the variables (p < 0.05). Results: The mean X-ray LLD (xLLD) was 1.39 mm (−7.43–11.63 mm) and Mako LLD (mLLD) was 4.77 mm (−6–12 mm) in Group I. The mean xLLD was 3.54 mm (−5.02–13.6 mm) and mLLD was 4.20 mm (−22–14 mm) in Group II. The mean xLLD was 4.06 mm (−8.62–21.2 mm) in Group III. There was no statistical significance between the three groups (p = 0.241). Conclusions: Using the lateral femoral epicondyle as a landmark for the limb length measurement is a viable alternative to the intrapatella landmark in rTHA. This method may save time and offer and more convenient technique in measuring leg length changes during robotic-assisted total hip arthroplasty. Full article

(This article belongs to the Special Issue Hip and Knee Replacement: Clinical Advances and Current Challenges)

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17 pages, 3656 KiB

Open AccessArticle

Multi-Directional Crosswalk of the Harris Hip Score and the Hip Disability and Osteoarthritis Outcome Score

by Chan Hee Cho, Kerry Costi, Deepti Sharma, Dominic Thewlis, Lucian B. Solomon and Stuart A. Callary

J. Clin. Med. 2025, 14(5), 1432; https://doi.org/10.3390/jcm14051432 - 20 Feb 2025

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Abstract

Background: Despite the popularity of the modified Harris Hip Score (mHHS) to monitor patient-reported outcome measures (PROMs) following Total Hip Arthroplasty (THA) over the last 5 decades, International Joint Registries have recently favoured the Hip disability and Osteoarthritis Outcome Score (HOOS). The ability to convert mHHS collected in historical and ongoing studies would be beneficial to benchmark more recent HOOS reports. Hence, this study aimed to create multi-directional crosswalks between mHHS and HOOS. Methods: Forty-nine patients undergoing primary THA prospectively completed both HHS and HOOS forms pre-operatively and at either 3, 6 and/or 12 months postoperatively. The Equipercentile (EQ) and Linear Regression (LR) crosswalk methodology were used. The Mean Absolute Error (MAE) of the crosswalk-derived scores was established against patient-derived (PD) scores. Results: There was a strong correlation between PD mHHS and HOOS (0.90) and HOOS-12 (0.90). The MAE of mHHS-to-HOOS-12 crosswalk was 10.4 (EQ) and 10.1 (LR). Subcategory activity had a larger contribution towards the error in the crosswalks than pain. Conclusions: This is the first crosswalk to facilitate conversion of mHHS and HOOS scores, which are required in long-term THA quality-assurance and research studies, which often span 2 decades of expected implant survivorship. Full article

(This article belongs to the Special Issue Hip and Knee Replacement: Clinical Advances and Current Challenges)

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10 pages, 960 KiB

Open AccessArticle

Subsidence and Clinical Impact of Obesity in Short-Stem Total Hip Arthroplasty Using a Collarless, Triple-Tapered, Cementless Stem

by Michael Stephan Gruber, Johannes Schöning, Martin Bischofreiter, Harald Kindermann, Arndt-Peter Schulz, Nico Hinz, Emanuel Mayböck and Reinhold Ortmaier

J. Clin. Med. 2024, 13(24), 7596; https://doi.org/10.3390/jcm13247596 - 13 Dec 2024

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Abstract

Background: Short-stem total hip arthroplasty (THA) has gained popularity due to its bone-sparing technique, but its outcomes in patients with obesity remain uncertain. The aim of this study was to investigate the impact of obesity on postoperative subsidence and clinical outcomes after short-stem THA. Methods: A retrospective cohort study with a minimum follow-up of 24 months was conducted on 163 patients who underwent short-stem THA with a collarless, triple-tapered, cementless stem achieving fixation in the metaphyseal region. Patients were categorized into obesity (Body Mass Index, BMI ≥ 30 kg/m²) and nonobesity (BMI < 30 kg/m²) groups. Subsidence rates, clinical outcomes, and complications were analyzed to assess the influence of BMI on the outcome of short stem THA. Regression analysis was performed to assess the influence of the independent variables (BMI, stem size, deviation from planning) on subsidence. Results: The obesity group (mean follow-up 58.6 months) exhibited significantly greater subsidence rates than did the nonobesity group (mean follow-up 38.9 months; 2.6 mm vs. 2.2 mm, p = 0.015). After removal of outliers, regression analysis revealed no linear relationship between BMI and subsidence (p = 0.35), but planned stem size was significantly correlated with subsidence (p = 0.005). Moreover, patients with obesity and larger planned stem sizes experienced greater subsidence. Clinical outcomes improved significantly in both groups. Conclusions: Obesity is associated with increased subsidence in short-stem THA, particularly in patients with larger planned stem sizes. Although BMI alone may not predict subsidence, careful selection of stem size and precise imaging techniques are crucial for minimizing subsidence risk in patients with obesity. Full article

(This article belongs to the Special Issue Hip and Knee Replacement: Clinical Advances and Current Challenges)

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10 pages, 2386 KiB

Open AccessArticle

Single-Taper Conical Tapered Stem in Total Hip Arthroplasty for Primary Osteoarthritis: A Comparative Long-Term Registry Evaluation

by Francesco Castagnini, Barbara Bordini, Monica Cosentino, Mara Gorgone, Andrea Minerba, Marco Rotini, Emanuele Diquattro and Francesco Traina

J. Clin. Med. 2024, 13(19), 5943; https://doi.org/10.3390/jcm13195943 - 6 Oct 2024

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Abstract

Background/Objectives: Single-taper conical tapered stems (STCTSs) are possible options for femoral reconstruction in THA performed for primary osteoarthritis, but outcomes are poorly ascertained. A specific STCTS in THA performed for primary osteoarthritis was investigated and compared to a control group including all the other cementless stems, aiming to assess the following: (1) the survival rates of the two cohorts and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failures for stem failure, stem aseptic loosening, and periprosthetic fracture. Methods: A regional arthroplasty registry study evaluating a specific STCTS in THA performed for primary osteoarthritis was designed. A control group including all the other cementless stems was considered. Results: In total, 1773 STCTSs were compared to 37,944 cementless stems. The cumulative survivorship of the STCTS cohort was 95.6% at 10 years and 92.7% at 15 years, which was not different to the control group (p = 0.252). After age stratification, the hazard ratio for STCTS failure was not different to the control group. With stem revision as the endpoint, the STCTS cohort outperformed the control group (at 10 years, 98% versus 96.8%; p < 0.001). The STCTSs achieved better survival rates in females <65 years (p = 0.023). With stem aseptic loosening as the endpoint, the survival rates did not differ between the two cohorts (p = 0.085), as well as the adjusted hazard ratios (p = 0.264). With periprosthetic fracture as the endpoint, the survival rates were better for the STCTSs (p < 0.001). Conclusions: STCTSs in THA for primary osteoarthritis provided dependable long-term outcomes, not inferior to all the other cementless stems with various designs. Full article

(This article belongs to the Special Issue Hip and Knee Replacement: Clinical Advances and Current Challenges)

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9 pages, 633 KiB

Open AccessArticle

Increased Duration of Total Hip and Total Knee Arthroplasty Surgery Increases the Risk of Post-Operative Urinary Retention: A Retrospective Cohort Study

by Edwin Yuen Hao Tong, Mariam Sattar, Iain A. Rankin and George Patrick Ashcroft

J. Clin. Med. 2024, 13(11), 3102; https://doi.org/10.3390/jcm13113102 - 25 May 2024

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Abstract

Background: Post-operative urinary retention (POUR) is a common complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Spinal anaesthetic has been associated with an increased risk of POUR, whilst other risk factors remain unclear. This study aims to identify modifiable and non-modifiable risk factors of POUR for THA and TKA patients. Methods: A single-centre retrospective cohort study of patients admitted to our hospital over the course of 6 weeks from September to October 2021 for a THA or TKA. All patients who underwent elective THA/TKA were included, and trauma cases were excluded. Results: Ninety-two consecutive patients were included in this study. The overall rate of POUR was 17%. A shorter operative duration resulted in a reduced risk of POUR (median duration of non-retention patients, 88 min vs. 100 min POUR patients; odds ratio, 0.97; 95% CI, 0.95–0.99, p = 0.018). The median bladder volume of patients with urinary retention at the point of diagnosis was 614 mL (range, 298–999 mL). The arthroplasty type, anaesthetic technique, pre-operative morphine use, body mass index, age, cardiovascular disease, and renal disease were found to have no significant association with POUR. Conclusions: A reduced operative time of arthroplasty surgery is associated with a decreased risk of POUR. Patients with a prolonged operative time should have an increased frequency of micturition monitoring in the immediate post-operative period. Full article

(This article belongs to the Special Issue Hip and Knee Replacement: Clinical Advances and Current Challenges)

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10 pages, 6394 KiB

Open AccessArticle

The Sum of the Leg Length Discrepancy and the Difference in Global Femoral Offset Is Equal to That of the Contralateral Intact Side and Improves Postoperative Outcomes after Total Hip Arthroplasty: A Three-Dimensional Analysis

by Norio Imai, Yuki Hirano, Yuki Endo, Yoji Horigome, Hayato Suzuki and Hiroyuki Kawashima

J. Clin. Med. 2024, 13(6), 1698; https://doi.org/10.3390/jcm13061698 - 15 Mar 2024

Cited by 2 | Viewed by 1298

Abstract

Background/Objectives: Global femoral offset (GFO) and leg length discrepancy (LLD) affect outcomes after total hip arthroplasty (THA). Moreover, the sum of the difference in GFO between the THA and non-surgical sides and LLD (SGL) reportedly affects the outcomes in a two-dimensional evaluation. We examined the association of the GFO, LLD, and SGL with the Harris Hip Score (HHS) using a three-dimensional (3D) evaluation. Methods: We retrospectively surveyed 172 patients with hemilateral hip osteoarthritis who underwent THA. The GFO, LLD, and SGL were measured using the 3D pelvis and femur models; these models were adjusted for the pelvis and femur, and the coordinate systems were parallelized. Furthermore, their relationship with the modified HHS (mHHS) 1 year after THA was determined. Results: Significant correlations were found among mHHS, GFO, and SGL in the binomial group, whereas LLD was not significantly correlated. The optimal values of GFO and SGL were 1.01 mm and 0.18 mm/100 cm body height, respectively, which were considered optimal when the SGL values were approximately equal to those of the non-operative side. The optimal ranges for GFO and SGL were −1.65 to 3.67 mm and −4.78 to 5.14 mm/100 cm, respectively. Conclusions: Our findings were obtained after adjusting the pelvis and femur to a unified coordinate system. Therefore, the results of this study can be directly applied to 3D planning. Full article

(This article belongs to the Special Issue Hip and Knee Replacement: Clinical Advances and Current Challenges)

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9 pages, 2234 KiB

Open AccessBrief Report

The Long-Term Efficacy of Computed Tomography-Navigated Total Hip Arthroplasty: An 18-Year Follow-Up Study

by Norio Imai, Dai Miyasaka, Shinya Ibuchi, Keishi Kimura, Yuki Hirano, Yoji Horigome and Hiroyuki Kawashima

J. Clin. Med. 2024, 13(5), 1374; https://doi.org/10.3390/jcm13051374 - 28 Feb 2024

Viewed by 995

Abstract

Backgroumd: There have been few reports on the long-term survival of computed tomography (CT)-navigated total hip arthroplasty (THA), which should lead to a lower incidence of dislocation and loosening. In this study, we examined survivorship, dislocation, and loosening incidence using plain radiographs over a minimum 15-year follow-up after CT-navigated THA.Methods: We retrospectively reviewed 145 consecutive CT-navigated THAs for >15 years. We surveyed the angles placed in both the acetabular and femoral components, survivorship, the occurrence of dislocation, the revision rate, and the fixation grade of the acetabular component. Results: The mean follow-up duration was 18.4 years. Overall, 73.8% of THAs were within the safe zone of Lewinnek. There were four dislocations (2.8%), with three occurring within 1 month after surgery and the other within 7 years after surgery. Revision THA was performed in one case (0.69%); consequently, the survival rate was 99.3%. The fixation grade was evaluated in 144 hips, and those were evaluated as having “no loosening”. Conclusions: CT-navigated THA was speculated to contribute to long-term survivorship, with a low rate of loosening, even after 18 years of follow-up. It was speculated that the acetabular component was placed at an acceptable insertion angle and a suitable position for stable initial fixation. Full article

(This article belongs to the Special Issue Hip and Knee Replacement: Clinical Advances and Current Challenges)

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