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What’s New in Hip Surgery 2025

OrthoBuzz for Surgeons
Hip radiograph.

Recent findings in hip surgery are presented in the new JBJS Guest Editorial What’s New in Hip Surgery. Here, we highlight the 5 most impactful studies, as selected by coauthor Lisa C. Howard, MD, FRCSC, MHSc.

Component Design and Technology

A randomized controlled trial (RCT) studied the accuracy of conventional vs. robotic-assisted total hip arthroplasty (THA) in achieving the preplanned center of rotation in 60 patients treated for symptomatic hip osteoarthritis. Robotic-assisted THA demonstrated greater accuracy than conventional THA (center-of-rotation median error, 1.4 and. 4.3 mm, respectively; p < 0.001)1.

Antibiotics and THA

The efficacy of adding 1.5 g of vancomycin to standard cefazolin prophylaxis was investigated in an RCT that included >4,000 patients undergoing hip, shoulder, or knee arthroplasty. Vancomycin plus cefazolin was not superior to cefazolin-only prophylaxis in reducing surgical site infections. Additionally, the vancomycin group demonstrated a greater risk of hypersensitivity reactions (1.2% vs. 0.5%)2.

A systematic review of 11 studies (1,276,663 patients) demonstrated that true penicillin allergy is less prevalent than reported by patients, with a rate of 0.7% to 3.0%. The review also pointed toward a possible association between the administration of second-line antibiotics and a higher rate of infection in patients with a purported penicillin allergy, although the literature was inconclusive3.

Perioperative Hematologic Advancements

The cost-effectiveness of aspirin vs. enoxaparin for 90-day venous thromboembolism (VTE) prevention in total hip or knee arthroplasty was compared using data from the CRISTAL trial4. The economic analysis showed that the decreased cost of VTE events “did not outweigh the increased cost of enoxaparin,” explain Guest Editorial authors Drs. Howard and Seah, who note that “The [study] authors conceded that the trial was not powered for a cost analysis, which may have impacted the results.”

Surgical Approach

Investigators evaluated the midterm outcomes of 93 patients who had received either the direct anterior approach (DAA) or the mini-posterior approach in THA. Although DAA was associated with faster early recovery, there were no meaningful clinical differences at a mean follow-up of 7.5 years5.

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 Orthopaedic Trauma.

References

  1. Fontalis A, Kayani B, Plastow R, Giebaly DE, Tahmassebi J, Haddad IC, Chambers A, Mancino F, Konan S, Haddad FS. A prospective randomized controlled trial comparing CT-based planning with conventional total hip arthroplasty versus robotic arm-assisted total hip arthroplasty. Bone Joint J. 2024 Apr 1;106-B(4):324-35.
  2. Peel TN, Astbury S, Cheng AC, Paterson DL, Buising KL, Spelman T, Tran-Duy A, Adie S, Boyce G, McDougall C, Molnar R, Mulford J, Rehfisch P, Solomon M, Crawford R, Harris-Brown T, Roney J, Wisniewski J, de Steiger R; ASAP Trial Group. Trial of vancomycin and cefazolin as surgical prophylaxis in arthroplasty. N Engl J Med. 2023 Oct 19;389(16):1488-98.
  3. Porto JR, Lavu MS, Hecht CJ 2nd, McNassor R, Burkhart RJ, Kamath AF. Is penicillin allergy a clinical problem? A systematic review of total joint arthroplasty procedures with implications for patient safety and antibiotic stewardship. J Arthroplasty. 2024 Jun;39(6):1616-23.
  4. CRISTAL Economic Analysis Study Group. Cost-effectiveness of enoxaparin versus aspirin in the prevention of venous thromboembolism after total hip or knee arthroplasty: an analysis from the CRISTAL cluster-randomized trial. Bone Joint J. 2024 Jun 1;106-B(6):589-95.
  5. Roberts HJ, Hadley ML, Mallinger BD, Sierra RJ, Trousdale RT, Pagnano MW, Taunton MJ. A randomized clinical trial of direct anterior versus mini-posterior total hip arthroplasty: small, early functional differences did not lead to meaningful clinical differences at 7.5 years. J Arthroplasty. 2024 Sep;39(9S1):S97-100.
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