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Plastic Surgery72 papers

Secondary osteoarthritis of left hip

Last edited: 2 h ago

Overview

Secondary osteoarthritis of the left hip typically arises from previous trauma, congenital abnormalities, or prior surgical interventions such as hip dysplasia repair or earlier total hip arthroplasty (THA). This condition significantly impairs mobility and quality of life, often necessitating further surgical intervention. It predominantly affects older adults but can occur in younger individuals with a history of hip pathology. Understanding the nuances of secondary osteoarthritis is crucial for clinicians to optimize patient outcomes and minimize complications, particularly in the context of revision THA. 1 5 15

Pathophysiology

Secondary osteoarthritis of the hip develops through a cascade of biomechanical and biological processes initiated by initial insults such as acetabular dysplasia, trauma, or previous surgical disruptions. These initial events lead to altered joint mechanics, increased stress on articular cartilage, and subsequent cartilage degeneration. Over time, this degeneration triggers an inflammatory response characterized by synovitis, the release of catabolic cytokines (e.g., IL-1, TNF-α), and the activation of osteoclasts, which promote bone resorption and osteophyte formation. Additionally, wear debris from polyethylene components in THA can induce periprosthetic osteolysis and further compromise implant stability. The cumulative effect is progressive joint space narrowing, subchondral bone sclerosis, and functional impairment characteristic of osteoarthritis. 1 2 5 10 13

Epidemiology

The incidence of secondary osteoarthritis following hip dysplasia repair or previous THA varies but is notable, particularly in populations with a history of these conditions. Age and sex distribution often skew towards older adults, with females potentially at higher risk due to anatomical predispositions like hip dysplasia. Geographic and socioeconomic factors can influence access to early intervention, thereby affecting prevalence. Trends indicate an increasing incidence with aging populations and higher rates of primary THA, suggesting a growing need for revision surgeries. Specific incidence figures are not universally reported, but studies suggest that up to 27% of THA patients may experience complications necessitating revision, including secondary osteoarthritis. 1 5 15 28

Clinical Presentation

Patients with secondary osteoarthritis of the left hip typically present with chronic hip pain, often exacerbated by weight-bearing activities. Symptoms may include stiffness, reduced range of motion, and a sensation of catching or clicking within the joint. A limp or altered gait pattern is common, reflecting compensatory mechanisms for pain and instability. Red-flag features include unexplained weight loss, significant night pain, and rapid progression of symptoms, which may warrant further investigation for underlying malignancy or infection. 1 5 25

Diagnosis

The diagnostic approach for secondary osteoarthritis involves a comprehensive clinical evaluation complemented by imaging studies. Key diagnostic criteria include:

Clinical History and Examination: Detailed history of prior hip surgeries, trauma, or dysplasia treatments; presence of pain, stiffness, and functional limitations.

Radiographic Imaging:

- X-rays: Essential for assessing joint space narrowing, osteophyte formation, subchondral sclerosis, and implant positioning in cases of THA. - CT/MRI: Useful for detailed evaluation of bone structure, soft tissue involvement, and assessing the integrity of prosthetic components.

Laboratory Tests: Routine blood tests to rule out inflammatory or infectious etiologies (e.g., ESR, CRP, WBC count).

Differential Diagnosis:

Avascular Necrosis: Typically presents with acute onset of pain and characteristic radiographic findings like crescent sign.

Hip Infection: Fever, elevated inflammatory markers, and imaging suggestive of soft tissue swelling or gas in the joint space.

Prosthetic Loosening: Increased radiolucency around the implant, migration of components on serial imaging.

Management

Initial Management

Non-operative Measures:

- Pain Management: NSAIDs or COX-2 inhibitors for pain relief (e.g., celecoxib 200 mg daily). - Physical Therapy: Focus on strengthening hip abductors and improving range of motion. - Weight Management: Reducing mechanical stress on the hip joint.

Surgical Intervention

Revision Total Hip Arthroplasty (THA):

- Indications: Severe pain, functional impairment, radiographic evidence of advanced osteoarthritis or prosthetic failure. - Bearing Choices: - Ceramic-on-Polyethylene (CoP): Lower wear rates compared to metal-on-polyethylene (MoP) 28. - Highly Cross-Linked Polyethylene (HXLPE): Reduced wear and improved longevity 13 17. - Ceramic-on-Ceramic (CoC): Considered in younger patients due to lower wear rates but with potential risks of ceramic fracture 19 20. - Implant Selection: Careful consideration of head size, cup design, and fixation method (cemented vs. cementless). - Limb Length Correction: Addressing any limb length discrepancy to prevent postoperative complications 3 8.

Postoperative Care

Rehabilitation: Gradual weight-bearing exercises, physical therapy tailored to restore function.

Monitoring: Regular follow-up with clinical assessment and imaging to monitor implant stability and patient outcomes.

Contraindications:

Severe systemic comorbidities precluding surgery.

Active infection or uncontrolled inflammatory conditions.

Complications

Acute Complications:

- Dislocation: Risk factors include improper positioning and soft tissue tension; managed with reduction and immobilization. - Infection: Early signs include fever, elevated inflammatory markers; requires urgent surgical debridement and antibiotics.

Long-term Complications:

- Periprosthetic Osteolysis: Wear debris from polyethylene components; monitored via serial imaging. - Limb Length Discrepancy: Can lead to back pain and gait abnormalities; managed with corrective osteotomies or prosthetic adjustments. - Component Loosening: Indicated by pain and radiographic changes; revision surgery may be necessary.

Prognosis & Follow-up

The prognosis for patients undergoing revision THA for secondary osteoarthritis varies but generally improves with successful surgical intervention. Key prognostic indicators include preoperative functional status, severity of osteoarthritis, and adequacy of implant positioning. Recommended follow-up intervals typically include:

Immediate Postoperative: 2-4 weeks for wound healing and early mobilization assessment.

6 Months: Radiographic evaluation and functional status reassessment.

Annually: Long-term monitoring of implant stability, wear, and patient-reported outcomes (e.g., Forgotten Joint Score [FJS-12]).

Special Populations

Elderly Patients: Higher risk of complications; careful risk stratification and tailored rehabilitation plans are essential.

Younger Patients: Greater emphasis on durable bearing surfaces like ceramic-on-ceramic to extend implant longevity.

Patients with Prior Hip Dysplasia Repair: Increased risk of recurrent dysplasia; meticulous preoperative planning and intraoperative adjustments are crucial.

Key Recommendations

Perform Comprehensive Preoperative Assessment Including detailed history, physical examination, and imaging to evaluate the extent of osteoarthritis and prosthetic status. (Evidence: Moderate)

Consider Highly Cross-Linked Polyethylene (HXLPE) in Revision THA To reduce wear and improve long-term implant survival. (Evidence: Strong)

Address Limb Length Discrepancy During Surgery To minimize postoperative complications such as back pain and gait abnormalities. (Evidence: Moderate)

Use Ceramic-on-Polyethylene (CoP) or Ceramic-on-Ceramic (CoC) Bearings In appropriate patients to enhance wear resistance and longevity. (Evidence: Moderate)

Implement Rigorous Postoperative Rehabilitation To optimize functional outcomes and prevent complications. (Evidence: Moderate)

Regular Follow-Up Monitoring Including clinical evaluation and imaging to detect early signs of implant loosening or wear. (Evidence: Moderate)

Evaluate and Manage Periprosthetic Complications Promptly Such as infection or osteolysis to prevent further joint damage. (Evidence: Strong)

Tailor Surgical Approaches Based on Patient Age and Comorbidities Ensuring individualized care plans. (Evidence: Expert opinion)

Utilize Advanced Imaging Techniques Such as MRI and CT for detailed assessment of soft tissue and bone structures preoperatively. (Evidence: Moderate)

Consider Patient-Specific Factors Like prior surgical history and functional demands when selecting implant design and fixation methods. (Evidence: Moderate)

References

1 Ishida T, Takahashi Y, Tateiwa T, Masaoka T, Shishido T, Seki T et al.. Progressive wear divergence beyond 10 years in ceramic- vs. metal-on-polyethylene bearings: the 25-year impact of zirconia degradation in total hip arthroplasty. Journal of orthopaedic surgery and research 2026. link 2 Pagano S, Plate JF, Kappenschneider T, Reinhard J, Scharf M, Maderbacher G. Polyethylene liner dissociation in total hip arthroplasty: a retrospective case-control study on a single implant design. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology 2024. link 3 Wu J, Zhuang X, Lin C, He L, Zhang R. Does the use of intraoperative measurement reduce limb length discrepancies after total hip arthroplasty?. BMC musculoskeletal disorders 2023. link 4 Kawakami T, Imagama T, Matsuki Y, Okazaki T, Kaneoka T, Sakai T. Forgotten joint score is worse when the affected leg perceived longer than shorter after total hip arthroplasty. BMC musculoskeletal disorders 2023. link 5 Terjesen T. The natural history of acetabular dysplasia and later total hip arthroplasty in late-detected DDH: 48 patients with closed reduction followed to a mean age of 62 years. Acta orthopaedica 2023. link 6 Kobayashi T, Morimoto T, Hirata H, Yoshihara T, Tsukamoto M, Sonohata M et al.. Changes of the coronal lumbar-pelvic-femoral alignment after conversion total hip arthroplasty in patients with unilateral ankylosed hip. Scientific reports 2023. link 7 Rouzrokh P, Wyles CC, Philbrick KA, Ramazanian T, Weston AD, Cai JC et al.. A Deep Learning Tool for Automated Radiographic Measurement of Acetabular Component Inclination and Version After Total Hip Arthroplasty. The Journal of arthroplasty 2021. link 8 Betsch M, Michalik R, Graber M, Wild M, Krauspe R, Zilkens C. Influence of leg length inequalities on pelvis and spine in patients with total hip arthroplasty. PloS one 2019. link 9 Peters RM, Van Steenbergen LN, Stevens M, Rijk PC, Bulstra SK, Zijlstra WP. The effect of bearing type on the outcome of total hip arthroplasty. Acta orthopaedica 2018. link 10 Migaud H, Putman S, Kern G, Isida R, Girard J, Ramdane N et al.. Do the Reasons for Ceramic-on-ceramic Revisions Differ From Other Bearings in Total Hip Arthroplasty?. Clinical orthopaedics and related research 2016. link 11 Triantafyllopoulos GK, Elpers ME, Burket JC, Esposito CI, Padgett DE, Wright TM. Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties. Clinical orthopaedics and related research 2016. link 12 Kurtz SM, MacDonald DW, Mont MA, Parvizi J, Malkani AL, Hozack W. Retrieval analysis of sequentially annealed highly crosslinked polyethylene used in total hip arthroplasty. Clinical orthopaedics and related research 2015. link 13 Kurtz SM, Gawel HA, Patel JD. History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clinical orthopaedics and related research 2011. link 14 Yoshitomi H, Shikata S, Ito H, Nakayama T, Nakamura T. Manufacturers affect clinical results of THA with zirconia heads: a systematic review. Clinical orthopaedics and related research 2009. link 15 Bartoníček J, Fojtík P, Chochola A. Hip shelf arthroplasty for acetabular dysplasia in adolescents and adults long-term results. International orthopaedics 2026. link 16 Katanbaf R, Swartz GN, Dubin JA, Bains SS, Mont MA, Nace J et al.. Increased Lengths of Stay and Denial Rates Seen With Managed Care Organizations Following Total Hip Arthroplasty. The Journal of arthroplasty 2025. link 17 Salmons HI, Larson DR, Ortiguera CJ, Clarke HD, Spangehl MJ, Pagnano MW et al.. Multicenter Randomized Clinical Trial of Highly Cross-Linked Polyethylene Versus Conventional Polyethylene in 518 Primary TKAs at 10 Years. The Journal of bone and joint surgery. American volume 2025. link 18 El-Sahoury JAN, Kjærgaard K, Ovesen O, Hofbauer C, Overgaard S, Ding M. Vitamin E-diffused liners show less head penetration than cross-linked polyethylene liners in total hip arthroplasty: a ten-year multi-arm randomized trial. The bone & joint journal 2023. link 19 Park JW, Ko YS, Lee YK, Ha YC, Koo KH. Ten to 13-Year Results of Delta Ceramic-on-Ceramic Total Hip Arthroplasty in Patients Less Than 30 Years Old. The Journal of bone and joint surgery. American volume 2023. link 20 Park JW, Kim HS, Kim KC, Lee YK, Ha YC, Koo KH. A 10- to 12-year follow-up study of delta ceramic-on-ceramic total hip arthroplasty. Archives of orthopaedic and trauma surgery 2023. link 21 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. The Journal of arthroplasty 2022. link 22 McCarty CP, Park SH, Ho NC, Sangiorgio SN, Ebramzadeh E. Taper Material Loss in Total Hip Replacements: Is It Affected by Joint Friction?. The Journal of bone and joint surgery. American volume 2022. link 23 Lee HJ, Kim SH, Pujol N, Park YB. Total Knee Arthroplasty after Previous Ipsilateral Hip Arthroplasty Showed Lower Clinical Outcomes and Higher Leg Length Discrepancy Perception. The journal of knee surgery 2022. link 24 Yamazaki K, Imagama T, Matsuki Y, Seki T, Seki K, Sakai T. Evaluation of femoral anteversion, hip rotation, and lateral patellar tilt after total hip arthroplasty using a changeable neck system. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 2021. link 25 Adams CT, O'Leary RE, Gheewala RA, Roberts JT. Evolving Patient Perception of Limb Length Discrepancy Following Total Hip Arthroplasty. The Journal of arthroplasty 2021. link 26 Lee YK, Kim KC, Yoon BH, Kim TY, Ha YC, Koo KH. Cementless total hip arthroplasty with delta-on-delta ceramic bearing in patients younger than 30 years. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2021. link 27 Rasheed A, Shaukat MK, Alam F. Mean limb length discrepancy after total hip arthroplasty. Journal of Ayub Medical College, Abbottabad : JAMC 2020. link 28 Gosling OB, Ferreri TG, Khoshbin A, Whitehouse MR, Atrey A. A systematic review and meta-analysis of survivorship and wear rates of metal and ceramic heads articulating with polyethylene liners in total hip arthroplasty. Hip international : the journal of clinical and experimental research on hip pathology and therapy 2020. link 29 Yang YR, Yang XF, Duan HC, Qiao JQ. Cyclooxygenase-2 inhibitor rofecoxib prevents chondrocytes against hypertrophy via Wnt/β-catenin pathway. Journal of biological regulators and homeostatic agents 2020. link 30 Ors-Unsal A, Archodoulaki VM. Comparison of In-Vivo Performance Characteristics of First-Generation and Second-Generation Cross-Linked and Conventional Explants. The Journal of arthroplasty 2020. link 31 Braun S, Sonntag R, Schroeder S, Mueller U, Jaeger S, Gotterbarm T et al.. Backside wear in acetabular hip joint replacement. Acta biomaterialia 2019. link 32 Novoa-Parra CD, Pelayo-de Tomás JM, Gómez-Aparicio S, López-Trabucco RE, Morales-Suárez-Varela M, Rodrigo-Pérez JL. Primary total hip arthroplasty with fourth-generation ceramic bearings: Clinical and survival results with a minimum follow-up of 5 years. Revista espanola de cirugia ortopedica y traumatologia (English ed.) 2019. link 33 Langton DJ, Wells SR, Joyce TJ, Bowsher JG, Deehan D, Green S et al.. Material loss at the femoral head taper: a comparison study of the Exeter metal-on-polyethylene and contemporary metal-on-metal total hip arthroplasty. The bone & joint journal 2018. link 34 Sodhi N, Khlopas A, Sultan AA, Newman JM, Jaggard C, Mont MA et al.. Linear Wear Rates of a Highly Cross-Linked Polyethylene Hip Liner. Surgical technology international 2018. link 35 Sobieraj M, Marwin S. Ultra-High-Molecular-Weight Polyethylene (UHMWPE) in Total Joint Arthroplasty. Bulletin of the Hospital for Joint Disease (2013) 2018. link 36 Taniguchi N, Jinno T, Takada R, Koga D, Ando T, Okawa A et al.. Do screws and screw holes affect osteolysis in cementless cups using highly crosslinked polyethylene? A 7 to 10-year follow-up case-control study. Orthopaedics & traumatology, surgery & research : OTSR 2018. link 37 Takada R, Jinno T, Koga D, Hirao M, Muneta T, Okawa A. Comparison of wear rate and osteolysis between annealed and remelted highly cross-linked polyethylene in total hip arthroplasty. A case control study at 7 to 10 years follow-up. Orthopaedics & traumatology, surgery & research : OTSR 2016. link 38 Rozell JC, Courtney PM, Dattilo JR, Wu CH, Lee GC. Should All Patients Be Included in Alternative Payment Models for Primary Total Hip Arthroplasty and Total Knee Arthroplasty?. The Journal of arthroplasty 2016. link 39 Epinette JA, Jolles-Haeberli BM. Comparative Results From a National Joint Registry Hip Data Set of a New Cross-Linked Annealed Polyethylene vs Both Conventional Polyethylene and Ceramic Bearings. The Journal of arthroplasty 2016. link 40 Zietz C, Fabry C, Reinders J, Dammer R, Kretzer JP, Bader R et al.. Wear testing of total hip replacements under severe conditions. Expert review of medical devices 2015. link 41 Drobniewski M, Borowski A, Synder M, Sibiński M. Cementless total hip arthroplasty with BiCONTACT stem - go od results at long term of follow -up. Ortopedia, traumatologia, rehabilitacja 2014. link 42 Fan N, Morlock MM, Bishop NE, Huber G, Hoffmann N, Ciavarella M et al.. The influence of stem design on critical squeaking friction with ceramic bearings. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2013. link 43 Seymour KM, Atwood SA. Computational analysis of microstructure of ultra high molecular weight polyethylene for total joint replacement. Journal of biomechanical engineering 2013. link 44 Nourissat C, Essig J, Asencio G. The cementless anatomic Benoist Girard (ABG) II total hip arthroplasty: a minimum 8-year follow-up study. The Journal of arthroplasty 2013. link 45 Ravi B, Croxford R, Reichmann WM, Losina E, Katz JN, Hawker GA. The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007. Best practice & research. Clinical rheumatology 2012. link 46 Arndt C, Voigt C, Steinke H, Salis-Soglio GV, Scholz R. Experimental evidence of impingement induced strains at the interface and the periphery of an embedded acetabular cup implant. Journal of biomechanical engineering 2012. link 47 Walker J. Care of patients undergoing joint replacement. Nursing older people 2012. link 48 Waewsawangwong W, Goodman SB. Unexpected failure of highly cross-linked polyethylene acetabular liner. The Journal of arthroplasty 2012. link 49 Zingler K, Haeberle L, Kress A, Holzwarth U, Forst R, Mueller LA et al.. Comparison of cortical and cancellous bone remodeling of the pelvis after press-fit cup total hip arthroplasty dependent on patient and prosthesis-specific characteristics: a computed tomography-assisted osteodensitometry study in vivo. Biomedizinische Technik. Biomedical engineering 2011. link 50 Jentschke MW, Schultz W, Buchhorn GH. Factory-assembled polyethylene linings in metal backing show higher wear rates compared to equisized all-polyethylene sockets. The Journal of arthroplasty 2011. link 51 Ludwigs E, Bellmann M, Schmalz T, Blumentritt S. Biomechanical differences between two exoprosthetic hip joint systems during level walking. Prosthetics and orthotics international 2010. link 52 Yoon TR, Park KS, Song EK, Seon JK, Seo HY. New two-incision minimally invasive total hip arthroplasty: comparison with the one-incision method. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2009. link 53 Bennett D, Humphreys L, O'Brien S, Kelly C, Orr J, Beverland DE. Activity levels and polyethylene wear of patients 10 years post hip replacement. Clinical biomechanics (Bristol, Avon) 2008. link 54 Stuart Kerrigan C, McKenna SJ, Ricketts IW, Wigderowitz C. Automated assessment of polyethylene wear in cemented acetabular components using anteroposterior radiographs of total hip replacements. Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society 2008. link 55 Liang B, Kawanabe K, Ise K, Iida H, Nakamura T. Polyethylene wear against alumina and zirconia heads in cemented total hip arthroplasty. The Journal of arthroplasty 2007. link 56 Sarmiento A, Latta LL. A radiographic review of 135 total hip Charnley arthroplasties followed between 15 and 35 years. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca 2006. link 57 Berquist TH. Imaging of joint replacement procedures. Radiologic clinics of North America 2006. link 58 Minoda Y, Kadowaki T, Kim M. Acetabular component orientation in 834 total hip arthroplasties using a manual technique. Clinical orthopaedics and related research 2006. link 59 Bourne RB, Barrack R, Rorabeck CH, Salehi A, Good V. Arthroplasty options for the young patient: Oxinium on cross-linked polyethylene. Clinical orthopaedics and related research 2005. link 60 Hamilton WG, Hopper RH, Ginn SD, Hammell NP, Engh CA, Engh CA. The effect of total hip arthroplasty cup design on polyethylene wear rate. The Journal of arthroplasty 2005. link 61 Wroblewski BM, Siney PD, Fleming PA. Low-friction arthroplasty of the hip using alumina ceramic and cross-linked polyethylene. A 17-year follow-up report. The Journal of bone and joint surgery. British volume 2005. link 62 Shon WY, Baldini T, Peterson MG, Wright TM, Salvati EA. Impingement in total hip arthroplasty a study of retrieved acetabular components. The Journal of arthroplasty 2005. link 63 Capello WN, Dantonio JA, Feinberg JR, Manley MT. Alternative bearing surfaces: alumina ceramic bearings for total hip arthroplasty. Instructional course lectures 2005. link 64 Chiu KH, Shen WY, Cheung KW, Tsui HF. Primary exeter total hip arthroplasty in patients with small femurs: a minimal of 10 years follow-up. The Journal of arthroplasty 2005. link 65 Hartofilakidis G, Karachalios T. Total hip arthroplasty for congenital hip disease. The Journal of bone and joint surgery. 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Original source

[1]
Progressive wear divergence beyond 10 years in ceramic- vs. metal-on-polyethylene bearings: the 25-year impact of zirconia degradation in total hip arthroplasty. — Ishida T, Takahashi Y, Tateiwa T, Masaoka T, Shishido T, Seki T et al. Journal of orthopaedic surgery and research (2026)
[2]
Polyethylene liner dissociation in total hip arthroplasty: a retrospective case-control study on a single implant design. — Pagano S, Plate JF, Kappenschneider T, Reinhard J, Scharf M, Maderbacher G Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology (2024)
[3]
Does the use of intraoperative measurement reduce limb length discrepancies after total hip arthroplasty? — Wu J, Zhuang X, Lin C, He L, Zhang R BMC musculoskeletal disorders (2023)
[4]
Forgotten joint score is worse when the affected leg perceived longer than shorter after total hip arthroplasty. — Kawakami T, Imagama T, Matsuki Y, Okazaki T, Kaneoka T, Sakai T BMC musculoskeletal disorders (2023)
[5]
The natural history of acetabular dysplasia and later total hip arthroplasty in late-detected DDH: 48 patients with closed reduction followed to a mean age of 62 years. — Terjesen T Acta orthopaedica (2023)
[6]
Changes of the coronal lumbar-pelvic-femoral alignment after conversion total hip arthroplasty in patients with unilateral ankylosed hip. — Kobayashi T, Morimoto T, Hirata H, Yoshihara T, Tsukamoto M, Sonohata M et al. Scientific reports (2023)
[7]
A Deep Learning Tool for Automated Radiographic Measurement of Acetabular Component Inclination and Version After Total Hip Arthroplasty. — Rouzrokh P, Wyles CC, Philbrick KA, Ramazanian T, Weston AD, Cai JC et al. The Journal of arthroplasty (2021)
[8]
Influence of leg length inequalities on pelvis and spine in patients with total hip arthroplasty. — Betsch M, Michalik R, Graber M, Wild M, Krauspe R, Zilkens C PloS one (2019)
[9]
The effect of bearing type on the outcome of total hip arthroplasty. — Peters RM, Van Steenbergen LN, Stevens M, Rijk PC, Bulstra SK, Zijlstra WP Acta orthopaedica (2018)
[10]
Do the Reasons for Ceramic-on-ceramic Revisions Differ From Other Bearings in Total Hip Arthroplasty? — Migaud H, Putman S, Kern G, Isida R, Girard J, Ramdane N et al. Clinical orthopaedics and related research (2016)
[11]
Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties. — Triantafyllopoulos GK, Elpers ME, Burket JC, Esposito CI, Padgett DE, Wright TM Clinical orthopaedics and related research (2016)
[12]
Retrieval analysis of sequentially annealed highly crosslinked polyethylene used in total hip arthroplasty. — Kurtz SM, MacDonald DW, Mont MA, Parvizi J, Malkani AL, Hozack W Clinical orthopaedics and related research (2015)
[13]
History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. — Kurtz SM, Gawel HA, Patel JD Clinical orthopaedics and related research (2011)
[14]
Manufacturers affect clinical results of THA with zirconia heads: a systematic review. — Yoshitomi H, Shikata S, Ito H, Nakayama T, Nakamura T Clinical orthopaedics and related research (2009)
[15]
Hip shelf arthroplasty for acetabular dysplasia in adolescents and adults long-term results. — Bartoníček J, Fojtík P, Chochola A International orthopaedics (2026)
[16]
Increased Lengths of Stay and Denial Rates Seen With Managed Care Organizations Following Total Hip Arthroplasty. — Katanbaf R, Swartz GN, Dubin JA, Bains SS, Mont MA, Nace J et al. The Journal of arthroplasty (2025)
[17]
Multicenter Randomized Clinical Trial of Highly Cross-Linked Polyethylene Versus Conventional Polyethylene in 518 Primary TKAs at 10 Years. — Salmons HI, Larson DR, Ortiguera CJ, Clarke HD, Spangehl MJ, Pagnano MW et al. The Journal of bone and joint surgery. American volume (2025)
[18]
Vitamin E-diffused liners show less head penetration than cross-linked polyethylene liners in total hip arthroplasty: a ten-year multi-arm randomized trial. — El-Sahoury JAN, Kjærgaard K, Ovesen O, Hofbauer C, Overgaard S, Ding M The bone & joint journal (2023)
[19]
Ten to 13-Year Results of Delta Ceramic-on-Ceramic Total Hip Arthroplasty in Patients Less Than 30 Years Old. — Park JW, Ko YS, Lee YK, Ha YC, Koo KH The Journal of bone and joint surgery. American volume (2023)
[20]
A 10- to 12-year follow-up study of delta ceramic-on-ceramic total hip arthroplasty. — Park JW, Kim HS, Kim KC, Lee YK, Ha YC, Koo KH Archives of orthopaedic and trauma surgery (2023)
[21]
Long-Term Wear-Related Complications of Cross-Linked Versus Conventional Polyethylene After Total Hip Arthroplasty: A Meta-Analysis. — Yoon BH, Park JW, Lee YK, Koo KH, Chang CB The Journal of arthroplasty (2022)
[22]
Taper Material Loss in Total Hip Replacements: Is It Affected by Joint Friction? — McCarty CP, Park SH, Ho NC, Sangiorgio SN, Ebramzadeh E The Journal of bone and joint surgery. American volume (2022)
[23]
Total Knee Arthroplasty after Previous Ipsilateral Hip Arthroplasty Showed Lower Clinical Outcomes and Higher Leg Length Discrepancy Perception. — Lee HJ, Kim SH, Pujol N, Park YB The journal of knee surgery (2022)
[24]
Evaluation of femoral anteversion, hip rotation, and lateral patellar tilt after total hip arthroplasty using a changeable neck system. — Yamazaki K, Imagama T, Matsuki Y, Seki T, Seki K, Sakai T Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs (2021)
[25]
Evolving Patient Perception of Limb Length Discrepancy Following Total Hip Arthroplasty. — Adams CT, O'Leary RE, Gheewala RA, Roberts JT The Journal of arthroplasty (2021)
[26]
Cementless total hip arthroplasty with delta-on-delta ceramic bearing in patients younger than 30 years. — Lee YK, Kim KC, Yoon BH, Kim TY, Ha YC, Koo KH Hip international : the journal of clinical and experimental research on hip pathology and therapy (2021)
[27]
Mean limb length discrepancy after total hip arthroplasty. — Rasheed A, Shaukat MK, Alam F Journal of Ayub Medical College, Abbottabad : JAMC (2020)
[28]
A systematic review and meta-analysis of survivorship and wear rates of metal and ceramic heads articulating with polyethylene liners in total hip arthroplasty. — Gosling OB, Ferreri TG, Khoshbin A, Whitehouse MR, Atrey A Hip international : the journal of clinical and experimental research on hip pathology and therapy (2020)
[29]
Cyclooxygenase-2 inhibitor rofecoxib prevents chondrocytes against hypertrophy via Wnt/β-catenin pathway. — Yang YR, Yang XF, Duan HC, Qiao JQ Journal of biological regulators and homeostatic agents (2020)
[30]
Comparison of In-Vivo Performance Characteristics of First-Generation and Second-Generation Cross-Linked and Conventional Explants. — Ors-Unsal A, Archodoulaki VM The Journal of arthroplasty (2020)
[31]
Backside wear in acetabular hip joint replacement. — Braun S, Sonntag R, Schroeder S, Mueller U, Jaeger S, Gotterbarm T et al. Acta biomaterialia (2019)
[32]
Primary total hip arthroplasty with fourth-generation ceramic bearings: Clinical and survival results with a minimum follow-up of 5 years. — Novoa-Parra CD, Pelayo-de Tomás JM, Gómez-Aparicio S, López-Trabucco RE, Morales-Suárez-Varela M, Rodrigo-Pérez JL Revista espanola de cirugia ortopedica y traumatologia (English ed.) (2019)
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