What’s New in Hip Surgery 2023 

Periprosthetic joint infection, venous thromboembolism prevention, and implant cost-utility are among the focuses of the new JBJS Guest Editorial What’s New in Hip Surgery. Here, we highlight the 5 most impactful studies, as selected by authors Patrick M. Morgan, MD, and Nicholas P. Gannon, MD. 

Young Adult Hip Pathology 

A multicenter, randomized controlled trial (RCT) evaluated hip-related quality of life among patients ≥16 years of age with femoroacetabular impingement who underwent either hip arthroscopy (171 patients allocated) or a personalized hip therapy program (177 patients). Both groups demonstrated improvement in the International Hip Outcome Tool-33 score at the 12-month follow-up; the mean adjusted difference, which exceeded the minimum clinically important difference, was 6.8 points in favor of arthroscopy¹. 

Hip Fracture Management 

Utilizing economic data collected within the World Hip Trauma Evaluation 5 trial in the U.K., researchers analyzed the cost-utility of cemented vs. cementless hemiarthroplasty for the treatment of displaced intracapsular hip fractures in older adults. In the base-case analysis, cemented implants were demonstrated to be cost-saving (mean cost difference, –£961 [95% CI, –£2,292 to £370]) while increasing quality-adjusted life-years (mean QALY difference, 0.010 [95% CI, 0.002 to 0.017]). The analysis showed a higher probability of cost-effectiveness when extended from 4 months to 12 months postoperatively². 

Nonoperative Management of Osteoarthritis 

The relationship between preoperative corticosteroid injection and risk of periprosthetic joint infection (PJI) following total hip arthroplasty (THA) or total knee arthroplasty (TKA) was examined in a meta-analysis of 28 studies totaling 480,532 patients. Intra-articular corticosteroid injection was associated with PJI risk among patients undergoing THA (p = 0.001), with an increased infection risk if the injection had been performed within 3 months preoperatively (p = 0.045). No such associations were found for TKA³. 

Implant Design and Related Outcomes 

In a meta-analysis of 14 studies with a minimum follow-up of 10 years, researchers compared wear-related complications of highly cross-linked polyethylene (HXLPE) and conventional polyethylene liners in THA. HXLPE was associated with a reduced risk of all 5 complications studied: overall osteolysis, linear wear rate, excessive wear, overall wear-related revision, and revision for aseptic loosening. Notably, the rate of wear-related revision was 3% for HXLPE but 20% for conventional polyethylene⁴. 

Postoperative Care 

Investigators conducted a cluster-randomized, crossover trial of 9,203 adults to compare aspirin and enoxaparin in the prevention of symptomatic venous thromboembolism (VTE) following THA and TKA. Symptomatic VTE occurred in 256 patients, with a higher rate found in the aspirin group (3.45%) than in the enoxaparin group (1.82%). Therefore, aspirin did not meet the criterion for noninferiority to enoxaparin, and enoxaparin was significantly superior (p = 0.007)⁵. 

What’s New in Hip Surgery is freely available at JBJS.org. 

What’s New by Subspecialty 

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org. 

 Recent OrthoBuzz posts include: What’s New in Osteoporosis and Fragility Fractures, What’s New in Limb Lengthening and Deformity Correction, and What’s New in Musculoskeletal Infection. 

 References 

1. Griffin DR, Dickenson EJ, Achana F, Griffin J, Smith J, Wall PD, Realpe A, Parsons N, Hobson R, Fry J, Jepson M, Petrou S, Hutchinson C, Foster N, Donovan J. Arthroscopic hip surgery compared with personalised hip therapy in people over 16 years old with femoroacetabular impingement syndrome: UK FASHIoN Health Technol Assess. 2022 Feb;26(16):1-236.
2. Png ME, Petrou S, Fernandez MA, Achten J, Parsons N, McGibbon A, Gould J, Griffin XL, Costa ML; WHiTE 5 trial collaborators. Cost-utility analysis of cemented hemiarthroplasty versus hydroxyapatite-coated uncemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: the World Hip Trauma Evaluation 5 (WHiTE 5) trial. Bone Joint J. 2022 Aug;104-B(8):922-8.
3. Albanese J, Feltri P, Boffa A, Werner BC, Traina F, Filardo G. Infection risk increases after total hip arthroplasty within 3 months following intra-articular corticosteroid injection. A meta-analysis on knee and hip arthroplasty. J Arthroplasty. 2022 Dec 30:S0883-5403(22)01112-3.
4. Yoon BH, Park JW, Lee YK, Koo KH, Chang CB. Long-term wear-related complications of cross-linked versus conventional polyethylene after total hip arthroplasty: a meta-analysis. J Arthroplasty. 2022 Nov;37(11):2308-2315.e2.
5. Sidhu VS, Kelly TL, Pratt N, Graves SE, Buchbinder R, Adie S, Cashman K, Ackerman I, Bastiras D, Brighton R, Burns AWR, Chong BH, Clavisi O, Cripps M, Dekkers M, de Steiger R, Dixon M, Ellis A, Griffith EC, Hale D, Hansen A, Harris A, Hau R, Horsley M, James D, Khorshid O, Kuo L, Lewis P, Lieu D, Lorimer M, MacDessi S, McCombe P, McDougall C, Mulford J, Naylor JM, Page RS, Radovanovic J, Solomon M, Sorial R, Summersell P, Tran P, Walter WL, Webb S, Wilson C, Wysocki D, Harris IA; CRISTAL Study Group. Effect of aspirin vs enoxaparin on symptomatic venous thromboembolism in patients undergoing hip or knee arthroplasty: the CRISTAL randomized trial. 2022 Aug 23;328(8):719-27.