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Total Hip Arthroplasty Today: Trends, Challenges, and Future Directions

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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: 15 July 2026 | Viewed by 3200

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Special Issue Editor

Prof. Dr. Seung-Jae Lim

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Guest Editor

Department of Orthopedic Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea
Interests: hip; hip arthroplasty; fracture; arthroplasty; trauma surgery; osteoporosis

Special Issue Information

Dear Colleagues,

We invite you to contribute to JCM’s Special Issue titled “Total Hip Arthroplasty Today: Trends, Challenges, and Future Directions.”

Total hip arthroplasty (THA) continues to evolve rapidly, with advancements in surgical techniques, implant design, perioperative management, and patient-specific strategies.

Given your significant contributions and expertise in the field of hip arthroplasty and related orthopedic research, we invite you to submit articles and reviews on these topics.

This Special Issue will bring together cutting-edge research and expert insights addressing the following:

Recent trends in THA indications, techniques, and technologies;
Innovative implant designs and long-term survivorship;
Perioperative optimization, enhanced recovery protocols, and complication prevention;
Revision THA and management of complex cases;
Patient-reported outcomes and value-based care models;
Future directions including digital surgery, robotics, navigation, and AI integration.

Thank you for considering this invitation. We look forward to including your valuable work in this Special Issue.

Prof. Dr. Seung-Jae Lim
Guest Editor

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

complex hip arthroplasty
surgical technique
innovative implant
new technology
robotic surgery
navigation surgery
artificial intelligence
complications
periprosthetic joint infection
periprosthetic fracture
dislocation

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Published Papers (6 papers)

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15 pages, 777 KB

Open AccessArticle

Perioperative Outcomes of Cemented vs Cementless Total Hip Arthroplasty: A National Inpatient Sample Study of 81,668 Elective Procedures

by Assil Mahamid, Mustafa Yassin, Basil Habiballa, Mohanad Natsheh, Hamza Murad, Khaled Qassem, Dror Robinson, Barak Haviv, Ali Yassin and Muhammad Khatib

J. Clin. Med. 2026, 15(9), 3292; https://doi.org/10.3390/jcm15093292 - 25 Apr 2026

Viewed by 104

Abstract

Background: Cemented and cementless fixation techniques in total hip arthroplasty (THA) each present distinct biomechanical properties and perioperative risk profiles. While cementless fixation has gained increasing popularity, large-scale nationally representative comparisons of perioperative outcomes between cemented and cementless elective THA remain limited. This study aimed to compare complication rates, healthcare utilization, and temporal trends between cemented and cementless elective THA using the National Inpatient Sample. Methods: A retrospective cohort study was conducted using the National Inpatient Sample database from 2016 to 2021. Adult patients undergoing elective primary total hip arthroplasty were identified using ICD-10-PCS codes and categorized into cemented and cementless fixation groups. Patient demographics, comorbidities, indications, postoperative complications, length of stay, hospital charges, and in-hospital mortality were compared. Multivariate logistic regression analysis was performed to evaluate the independent association between fixation type and postoperative complications while adjusting for demographic, clinical, and hospital-level variables. Results: A total of 81,668 elective THAs were identified, including 40,290 cemented (49.33%) and 41,378 cementless (50.67%) procedures. Cemented THA was associated with a shorter length of stay (2.09 ± 1.88 vs. 2.26 ± 2.47 days, p < 0.001) and lower total hospital charges ($65,584.53 ± 48,797.21 vs. $72,186.84 ± 49,860.20, p < 0.001). Unadjusted analyses demonstrated higher rates of acute kidney injury and sepsis in the cementless group. After multivariate adjustment, cemented fixation was associated with lower odds of acute kidney injury (OR 0.87, 95% CI 0.79–0.96, p = 0.004). However, cemented THA was associated with higher odds of postoperative delirium (OR 1.20, 95% CI 1.02–1.42, p = 0.030), blood transfusion (OR 1.27, 95% CI 1.17–1.37, p < 0.001), and periprosthetic fracture (OR 1.32, 95% CI 1.02–1.71, p = 0.035). Rates of myocardial infarction, pneumonia, venous thromboembolism, urinary tract infection, and in-hospital mortality were similar between groups. Temporal analysis demonstrated comparable utilization trends, with a decline in elective procedures during 2020–2021. Conclusions: In this nationwide analysis, cemented total hip arthroplasty was associated with lower risk of acute kidney injury, shorter length of stay, and lower hospital charges, but higher odds of postoperative delirium, blood transfusion, and periprosthetic fracture compared with cementless fixation. These findings highlight distinct perioperative risk profiles between fixation strategies and may assist surgeons in individualized decision-making for elective total hip arthroplasty. Full article

(This article belongs to the Special Issue Total Hip Arthroplasty Today: Trends, Challenges, and Future Directions)

12 pages, 1109 KB

Open AccessArticle

Complications and Mortality of Open Reduction and Internal Fixation for Periprosthetic Femoral Fractures Around Cementless Femoral Stems: A Mid- to Long- Term Retrospective Cohort Study

by Sang Yoon Kang, Li Loong Loh, Hong Seok Kim and Jeong Joon Yoo

J. Clin. Med. 2026, 15(8), 2965; https://doi.org/10.3390/jcm15082965 - 14 Apr 2026

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Abstract

Background/Objectives: The optimal treatment strategy for periprosthetic femoral fractures (PFFs) around cementless femoral stems remains controversial, particularly for fractures in which stem stability is difficult to determine preoperatively. While revision arthroplasty is often recommended for unstable stems, open reduction and internal fixation (ORIF) continues to be widely used in clinical practice. This study aimed to evaluate mid- to long-term clinical outcomes, complications, and mortality of ORIF for PFFs around cementless stems. Methods: We retrospectively reviewed patients who underwent ORIF for PFFs around cementless femoral stems at a single tertiary referral center between March 2002 and March 2021. Clinical and radiographic outcomes, complications, reoperation, and mortality were assessed. Kaplan–Meier survival analysis was performed to estimate the survival rates for being free of revision and reoperation. Results: A total of 53 patients were included, with a mean follow-up of 4.4 years (range, 1.0 to 19.6). The mean age was 71.0 years, and 30 patients (56.6%) were female. Most fractures were Vancouver type B1 (84.9%). Radiographic union was achieved in 51 patients (96.2%), with a mean time to union of 20.5 weeks. The estimated revision-free survival was 98.1% (95% CI, 87.4–99.7%), and the reoperation-free survival rate was 94.3% (95% CI, 83.5–98.1%) at 5 years. The one- and five-year mortality rates were 5.7% and 22.6%, respectively. Conclusions: Open reduction and internal fixation for PFFs around cementless stems demonstrated acceptable mid- to long-term outcomes with comparable survivorship in selected patients. Although reoperations were not uncommon, mortality rates were comparable. ORIF may represent a reasonable treatment option in carefully selected patients, particularly those with high surgical risk. However, as the cohort was predominantly composed of B1 fractures, the findings should be interpreted primarily in the context of this fracture subtype. Full article

(This article belongs to the Special Issue Total Hip Arthroplasty Today: Trends, Challenges, and Future Directions)

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11 pages, 1550 KB

Open AccessArticle

Clinical Feasibility and Mechanical Reliability of a Modified Functional Articulating Hip Spacer Incorporating a Cemented Dual Mobility Bearing Metal Liner

by Sun-hyung Lee and Soong Joon Lee

J. Clin. Med. 2026, 15(6), 2309; https://doi.org/10.3390/jcm15062309 - 18 Mar 2026

Viewed by 263

Abstract

Background: Periprosthetic joint infection and native hip infections often require staged surgical intervention due to extensive bone and soft tissue destruction. This study evaluates the clinical feasibility and mechanical reliability of a modified functional articulating hip spacer (FAHS) incorporating a cemented dual-mobility-bearing (DMB) metal liner. Methods: We retrospectively reviewed the cases of 20 patients who underwent a DMB-incorporated FAHS between March 2018 and December 2019. The technique involved cementing a DMB metal liner directly into the prepared acetabulum without a standard outer shell. Successful clinical outcome was defined as either transition to second-stage total hip arthroplasty (THA) or stable spacer retention, the latter including cases with definitive eradication or symptom-controlled chronic suppression therapy. Infection eradication required the clinical absence of infection for at least twelve months following the cessation of antimicrobial therapy. Construct-related mechanical complications and radiographic parameters were also analyzed. Results: The mean follow-up was 23.5 months, ranging from 6.0 to 62.6 months. Successful clinical outcome was achieved in 17 patients (85%), with seven (35%) transitioning to second-stage THA and ten (50%) opting for spacer retention. Within the retention group, seven achieved definitive eradication while three were maintained under chronic suppression therapy. Construct integrity was maintained in 80% of the cohort. Mechanical complications included two dislocations (10%) and two implant failures (10%). Radiographic analysis showed higher inclination and anteversion angles of the metal liner in the dislocation cases. Conclusions: The off-label use of DMB-incorporated FAHS represents a feasible option with acceptable mechanical performance in selected cases of PJI and native hip joint infection. However, as mechanical complications cannot be fully prevented, meticulous surgical techniques and careful patient selection remain essential. Full article

(This article belongs to the Special Issue Total Hip Arthroplasty Today: Trends, Challenges, and Future Directions)

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10 pages, 3491 KB

Open AccessArticle

A Modern Collared Cementless Femoral Stem for the Arthroplasty Treatment of Femoral Neck Fractures

by Brandon H. Naylor, Mary Jane McConnell, Anita (Alex) Bradham, Natalie L. Gresham, Zachary M. Ricciardelli, Charlotte C. Baker, Brian E. Seng, Thomas L. Bradbury and Joseph M. Schwab

J. Clin. Med. 2026, 15(6), 2110; https://doi.org/10.3390/jcm15062110 - 10 Mar 2026

Viewed by 471

Abstract

Background/Objectives: For femoral neck fractures (FNFs) treated with hip arthroplasty, cemented femoral fixation is frequently recommended due to its association with reduced early perioperative fracture and reoperation rates. However, newer-generation collared, cementless triple-tapered (CCTT) stems may present benefits compared with conventional press-fit designs. This study sought to assess 30-day survivorship of a CCTT stem in patients undergoing hip arthroplasty for FNF via the direct anterior approach (DAA). Methods: We conducted a retrospective review of all patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for displaced FNF from 2019 to 2023. All procedures were performed through the DAA using a hydroxyapatite-coated CCTT femoral stem. The primary outcome was 30-day stem survival. Secondary outcomes included reoperation, stem revision, complications, readmission, and radiographic outcomes including intraoperative and postoperative periprosthetic fracture and subsidence. Results: A total of 184 patients were included (mean age 76.1 ± 10.0; 70.1% women). THA was performed in 77.7% and HA in 22.3%. At 30 days, no stems required revision. The 30-day reoperation rate was 3.5% (5/184). There were four intraoperative fractures: 3 (1.6%) Vancouver AG and 1 (0.5%) calcar. Postoperatively within 3 months, seven fractures occurred: five (2.7%) Vancouver AG and two (1.1%) Vancouver B1. Conclusions: Use of a modern CCTT femoral stem for FNF demonstrated excellent early survivorship with low rates of intraoperative and postoperative periprosthetic fracture, comparable to published outcomes of cemented fixation. These findings suggest that this stem design may represent a safe and efficient alternative to cemented femoral fixation in FNF. Further studies are warranted to evaluate mid- and long-term outcomes. Full article

(This article belongs to the Special Issue Total Hip Arthroplasty Today: Trends, Challenges, and Future Directions)

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10 pages, 2234 KB

Open AccessArticle

Mid-Term Results of Ceramic Monoblock Acetabular Cups in Primary Total Hip Arthroplasty: A Minimum 5-Year Follow-Up

by Chan Young Lee, Gong-Yeong Kim, Taek-Rim Yoon and Kyung-Soon Park

J. Clin. Med. 2026, 15(4), 1672; https://doi.org/10.3390/jcm15041672 - 23 Feb 2026

Viewed by 575

Abstract

Introduction: Ceramic-on-ceramic (CoC) articulation in total hip arthroplasty (THA) offers excellent wear characteristics but carries risks such as liner malseating and ceramic fracture. To solve these problems, monoblock acetabular cups with preassembled ceramic liners were developed to minimize technical errors and allow the use of larger femoral heads. This study aimed to evaluate the mid-term clinical and radiological outcomes of a ceramic monoblock acetabular cup system. Methods: A retrospective analysis was performed on 106 primary THAs in South Korean patients using the Maxera monoblock cup (Zimmer Biomet) between 2015 and 2018, with a minimum follow-up of 5 years. Clinical outcomes were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS). Radiologic evaluation included osteolysis and radiolucent lines. Normality of clinical variables was confirmed, and pre-to-postoperative comparisons were performed using paired t-tests. Results: The mean follow-up was 6.8 ± 1.4 years. The most common preoperative diagnosis was avascular necrosis (66.0%). Cups sized ≤52 mm were used in 80.2% of hips, allowing the frequent use of large femoral heads (32–40 mm). Clinical scores improved significantly: HHS from 37.0 ± 13.4 to 90.8 ± 6.2, WOMAC from 66.6 ± 11.5 to 7.6 ± 6.7, and VAS from 6.45 ± 1.1 to 1.1 ± 0.8 (p < 0.001). No osteolysis was observed. Radiolucent lines was appeared in four hips (3.7%) without evidence of migration or loosening. One cup fixation failure (0.9%) required revision. No cases of ceramic fracture, squeaking, or dislocation occurred. Conclusions: The ceramic monoblock acetabular cup demonstrated excellent mid-term clinical and radiological outcomes with a very low complication rate. The ability to reliably use large femoral heads likely contributed to enhanced joint stability. However, the absence of screw fixation and inability to directly visualize cup insertion require careful attention during cup impaction. Long-term studies with comparative cohorts are warranted. Full article

(This article belongs to the Special Issue Total Hip Arthroplasty Today: Trends, Challenges, and Future Directions)

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19 pages, 525 KB

Open AccessSystematic Review

Electromyography After Total Hip Arthroplasty: A Systematic Review of Neuromuscular Alterations and Functional Movement Patterns

by Maria Cesarina May, Andrea Zanirato, Luca Puce, Eugenio Giannarelli, Carlo Trompetto, Lucio Marinelli and Matteo Formica

J. Clin. Med. 2026, 15(1), 400; https://doi.org/10.3390/jcm15010400 - 5 Jan 2026

Viewed by 952

Abstract

Background: Electromyography (EMG) is increasingly used to characterize neuromuscular alterations after total hip arthroplasty (THA), yet available evidence remains fragmented and inconsistent. This systematic review synthesizes postoperative EMG findings during gait, functional tasks, and static assessments, highlighting clinical implications and future research needs. Methods: Peer-reviewed studies employing surface, needle, or high-density EMG after THA were systematically examined. Extracted variables included activation amplitude, timing (onset, offset, burst duration), co-activation patterns, and the influence of surgical approach. Methodological rigor, normalization procedures, and the extractability of quantitative EMG metrics were also assessed. Results: Across studies, postoperative EMG consistently revealed non-physiological activation patterns, including delayed or prolonged gluteus medius activity and excessive recruitment of posterior chain muscles. These abnormalities persisted for up to 12 months and, in isolated cases, beyond a decade. Comparisons of surgical approaches demonstrated early denervation signs and impaired recruitment following lateral-based incisions, whereas later adaptations differed between lateral and posterior approaches but remained abnormal in both. Needle EMG studies confirmed transient involvement of muscles innervated by the superior gluteal nerve, while high-density EMG identified persistent deficits in spatial and temporal organization despite clinical improvement. Load-bearing and assisted-task studies showed that cane use and balance challenges modulate abductor demand yet continue to expose asymmetries and elevated stabilization requirements. Nonetheless, comparability across investigations remains limited because few studies adopted standardized normalization procedures or reproducible locomotor tasks. Conclusions: Neuromuscular recovery after THA appears incomplete and asymmetric, characterized by compensatory strategies not detectable through clinical or kinematic assessments alone. Improved diagnostic sensitivity and clinical applicability will require protocol standardization and the broader adoption of advanced EMG approaches. Full article

(This article belongs to the Special Issue Total Hip Arthroplasty Today: Trends, Challenges, and Future Directions)

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