What's New in Hip Arthroplasty
Michael H. Huo, MD; Javad Parvizi, MD, PhD; Nathan F. Gilbert, MD

Surgeons and scientists have once again produced a large amount of data related to outcomes, biomaterials, surgical techniques, the treatment of complications, and socioeconomic issues related to total hip arthroplasty surgery. One recent debate in hip surgery is on the most efficacious treatment for displaced intracapsular hip fractures. Following the style of our previous Specialty Updates, this review is organized into seven sections: (1) primary surgery, (2) surface replacement, (3) revision surgery, (4) biomaterials and prosthetic design, (5) complications, (6) practice management, and (7) treatment of intracapsular hip fractures.

Primary Surgery

Minimal Incision Surgery

Total hip arthroplasty performed with use of smaller tissue-preserving techniques received intense initial popularity and scrutiny. There are now more data documenting differences among the various techniques. Moreover, the complication rate associated with certain techniques may be too high for patient safety.

Pagnano et al. performed staged bilateral total hip arthroplasties in twenty-six patients. One hip was treated with use of the two-incision technique, and the contralateral hip was treated with use of a mini-posterior approach. Sixteen of the twenty-six patients reported greater satisfaction on the side that had been treated with the miniposterior approach; the reasons cited included earlier recovery (50%), cosmetic appearance (25%), and a combination of reasons (25%). Eight patients preferred the side treated with the two-incision technique; all cited early recovery as the reason. Two patients had no preference. Sharkey and Hozack conducted a prospective, randomized study in which the standard approach was compared with the miniincision approach. They found no difference between the groups with regard to intraoperative blood loss, transfusions, operative time, or time to hospital discharge. Moreover, there was no difference with regard to patient outcome measurements such as the Harris hip score, the Short Form-36, and a validated rehabilitation improvement test at three to six months. The authors also evaluated the efficacy of …

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