Complications & Outcomes

Post-operative hip complications: management of dislocation, heterotopic ossification, and VTE prophylaxis across arthroscopy and arthroplasty.

Overview

Total joint arthroplasty demonstrates variable short-term complication profiles depending on the anatomical site and indication. Total elbow arthroplasty carries an overall short-term complication rate exceeding 10% requiring inpatient treatment, with nearly 8% of patients requiring reoperation within 90 days [1]. Complications for this procedure differ based on the implant of choice, with each possessing specific risks, while trauma indications appear to have higher complication rates than inflammatory arthropathy [12]. In the shoulder, complication and revision rates for unconstrained prostheses increase substantially with longer follow-up [3], whereas primary reverse total shoulder arthroplasty after 2010 reported an overall complication rate of 18.2% [13]. The risk of short-term complications is highest in primary shoulder arthroplasty performed for fracture compared with nonfracture indications [9].

Outcomes for reverse total shoulder arthroplasty vary widely, with complication rates ranging from 15% to 50% and reoperation rates from 4% to 40% across series [4]. This high variability is largely attributed to unclear definitions and small patient numbers in individual studies [4]. However, major complications for primary reverse total shoulder arthroplasty dropped three-fold from 15.4% to 4.6% after 2010 [13], and low complication rates with high patient satisfaction were reported at 2-year follow-up for uncemented reverse replacements in proximal humerus fractures [5]. Complications and reoperation rates following failure after reverse total shoulder arthroplasty remain significant [22].

In hip arthroplasty, safety outcomes for outpatient procedures in ambulatory surgery centers showed no differences based on the surgeon's preferred approach, with few complications in the 90-day period [8]. Total hip arthroplasty using either the direct anterior approach or posterior approach has no compelling advantage regarding short-term outcomes or complication data, including dislocation risk [29]. Conversely, total hip arthroplasty for Crowe Type IV dysplasia exhibits variable functional recovery and relatively high complication rates, particularly with tapered stems, and not all patients achieve optimal results [11]. Reported success rates for two-stage exchanges for prosthetic joint infection have not traditionally considered complications in the definition of success [32].

Anatomy & Pathophysiology

Kinematics and Biomechanics

The functional orientation of the acetabular component during activities associated with posterior edge-loading differs from those measured when supine due to patient-specific pelvic kinematics [72], while dynamic pelvic behavior may contribute to anterior instability patterns in patients with dislocation after total hip arthroplasty [82]. Robot-assisted total hip arthroplasty contributes to the restoration of the patient's original hip biomechanics compared to manual total hip arthroplasty [99]. Intraoperative mechanical injury of the femoral neck or malpositioning of the femoral component may lead to changes in loading patterns resulting in acute and chronic biomechanical femoral neck fractures after hip resurfacing arthroplasty [107]. Continuous dynamic stability of the hip may have contributed to the slight increase in the cumulative risk of dislocation after 1 month following direct anterior total hip arthroplasty [116].

Pathophysiology of Instability and Degeneration

Hip microinstability is a condition characterized by abnormal femoral head micromotion within the acetabulum, leading to cartilage damage and osteoarthritis [89], and is often associated with acetabular dysplasia or femoroacetabular impingement syndrome [89]. Anatomical restoration of the labrum and reduction of capsular laxity were key elements in reconstructing a stable hip in patients with recurrent dislocation and a labral lesion [119]. Caution is advised to avoid hip instability and subsequent osteoarthritis following arthroscopic debridement [122].

Risk Factors for Loosening and Revision

Factors potentially associated with the quality of bone bed and biomechanics of the hip might influence the risk of aseptic loosening in the cup of ABG I hip arthroplasty [90], with male gender, Charnley class C, and severity of bone defects predicting this risk [90]. The observed rates of volumetric wear in total hip arthroplasty suggest that the hips may require revision in the future [111]. Patients with preoperative acetabular morphological risk factors for dislocation might be better candidates for total hip arthroplasty than hemiarthroplasty for femoral neck fractures in the elderly [118].

Classification

Vancouver: This system guides the surgical approach for periprosthetic fractures based on fracture type. Vancouver B1 fractures are treated by fixation [18]. Vancouver B2 fractures are treated by revision with a long stem [18]. Vancouver B3 fractures are treated by complex reconstruction or prosthetic replacement [18] [18].

Unified Classification System (UCS): This system is unsatisfactory for classifying periprosthetic femoral fractures around polished taper-slip stems [66]. The UCS demonstrates considerably lower reliability and validity for these specific fractures than previously described for other stem types [66].

Gartland: The incidence of vascular and nerve complications in pediatric supracondylar humerus fractures positively correlates with the progression of fracture according to the Gartland classification [76].

Charnley: Detailed comorbidity measures have no added value to the preoperative Charnley classification in explaining patient-reported outcome score variability one year after total hip arthroplasty [97].

Other Considerations: High variability in complication, revision, and reoperation rates for reverse total shoulder arthroplasty is largely due to unclear definitions and small patient numbers in individual studies [4]. Complication and revision rates in reverse total shoulder arthroplasty vary from 15% to 50% across included series [4]. Reoperation rates in reverse total shoulder arthroplasty vary from 4% to 40% across included series [4]. Failure and revision rates after arthroscopic hip labral repair are not significantly different between looped and pierced suture techniques [16]. Suture type does not influence failure or revision rates after arthroscopic hip labral repair [16]. The rate of complications after hip arthroscopy is in line with complication rates after open surgical dislocation using the same classification system [23]. Both the Clavien-Dindo classification and Comprehensive Complication Index appear valid and applicable to patients undergoing total joint replacement [60]. The current classification for scapular fractures after reverse shoulder arthroplasty has only moderate reliability [65]. An alternative classification method is needed for scapular fractures after reverse shoulder arthroplasty due to the moderate reliability of the current classification [65]. A comprehensive system for the classification and management of spontaneous shoulder sepsis is based on stage and anatomy [67]. Preoperative MRI can aid in determining disease severity and surgical decision-making for spontaneous shoulder sepsis [67]. Different types of ninety-day readmissions following total joint replacement follow distinct patterns with different implications for perioperative care and follow-up [68]. A classification system and algorithmic approach exist to guide femoral reconstruction in revision total hip arthroplasty [70]. Specific implant strategies for femoral reconstruction in revision total hip arthroplasty are recommended based on the type of femoral deficiency to ensure stability and osseointegration [70]. ASA class significantly increases the risk of postoperative adverse events and hospital readmission within 30 days of open reduction and internal fixation for ankle fractures [78]. Various medical comorbidities significantly increase the risk of postoperative adverse events and hospital readmission within 30 days of open reduction and internal fixation for ankle fractures [78]. A standardized, four-tier outcome-reporting tool for periprosthetic joint infection treatment categorizes outcomes from infection control to death [92]. Self-rated health (SRH), ASA classification, and comorbidity count showed increasing risks of medical complications and death with decreasing health status in primary total hip arthroplasty [93].

Clinical Presentation

Management of complex orthopaedic scenarios hinges on the recognition of specific clinical patterns and risk stratification. Treatment of nonunion after periprosthetic femoral fracture associated with total hip arthroplasty is difficult, with a high rate of complications and relatively poor functional outcomes [2]. In contrast, timely diagnosis and intervention are the most critical prognostic factors for successful outcomes in the management of septic arthritis via hip arthroscopy [6]. Despite delayed presentation, open reduction and internal fixation (ORIF) achieved satisfactory anatomical and functional results in most cases of neglected acetabular fractures [14].

Patient-related factors significantly influence prognosis across various pathologies. Increasing age, male sex, and higher comorbidity are associated with a number of complications after hip fracture [31], while higher comorbidity and increasing age may explain the higher mortality and worse recovery seen in these groups [31]. Comorbidities determine the likelihood of early general complications following hip fracture, while poor cognitive status determines the likelihood of delayed general complications [36]. Patient comorbidities play a larger role than the procedure selected in predicting short-term complications for proximal humeral fractures [37]. Surgeons and patients must consider the impact of age on patient course and outcomes in elective total hip arthroplasties in nonagenarians regardless of the presence of comorbidities [30]. Patients who report adverse events have worse outcomes than those who do not, regardless of whether the adverse events can be confirmed by standard medical record review methods [26].

Specific diagnostic challenges arise from insidious or atypical presentations. Because clinical symptoms of calcaneal stress fracture appear insidiously and radiographic findings are absent or subtle in the early stage, a high index of suspicion is needed for orthopaedic surgeons to make the correct diagnosis [35]. Pain in the thigh following total hip replacement with a porous-coated anatomic prosthesis for osteoarthrosis continues to be a concern and may well indicate a poor prognosis [43]. Patients who had a preoperative diagnosis of osteonecrosis (ON) had worse clinical outcomes than those who had other diagnoses following osteochondral allograft transplantation for femoral head cartilage lesions [38]. The presence of symptoms does not significantly affect the prognosis for conversion to total hip replacement in core decompression cases for osteonecrosis of the femoral head (ONFH) [21]. Elderly patients with coexisting medical illnesses may present with symptoms and signs that differ from those with classic severe acute respiratory syndrome [45].

Red-Flag Patterns: - Compartment Syndrome: Prompt diagnosis of compartment syndrome of the foot after calcaneal fracture is essential to avoid devastating long-term sequelae [24]. - Vascular Injury: Prompt diagnosis and repair of false aneurysm of the popliteal artery prevents limb-threatening complications [39]. - Neuroendocrine Emergencies: Early diagnosis and immediate surgical intervention are required to improve the final outcome in cases of pituitary apoplexy after joint arthroplasty [25]. - Infection: Early diagnosis with prompt surgical treatment could lead to favourable recovery in cases of simultaneous bilateral femoral neck fractures in a dialysis-dependent patient [42], and early diagnosis and operative management are necessary to provide the best prognosis for early periprosthetic infection after primary total hip arthroplasty caused by Citrobacter koseri [41]. - Visceral Complications: Recognition by the orthopaedic surgeon of the presenting features of acute colonic pseudo-obstruction is important to facilitate prompt initiation of treatment, which may hasten recovery and reduce morbidity and mortality [28].

Investigations

Plain radiography: Immediate postoperative radiographs following shoulder arthroplasty rarely identify complications (0.2%) [27], yet immediate X-rays for primary total hip arthroplasty are often of suboptimal quality, possess minimal clinical utility, and are less cost-effective [83]. While open reduction and internal fixation (ORIF) achieved satisfactory results in neglected acetabular fractures despite delayed presentation [14], radiographic and clinical outcomes for shoulder arthroplasty appear to deteriorate over time [59]. Intraoperative femoral fractures during cemented hemiarthroplasty do not adversely affect postoperative radiographic outcomes [62], and radiological changes after reverse shoulder arthroplasty remain frequent but rarely influence final patient outcomes [63]. Cortical hypertrophy with a short, curved uncemented hip stem is frequently displayed on postoperative radiographs but has no significant effect on early clinical outcomes [79]. Radiolucent lines around a highly porous titanium cup (Tritanium) after total hip arthroplasty are not related to postoperative clinical evaluation [84]. Assessment of periprosthetic bone loss on plain radiographs is unreliable for outcomes research, as loss is not reproducibly recognized until 70 percent of the bone is gone [69]. Preoperative plain radiographs are less important for predicting instability recurrence after arthroscopic Bankart repair, necessitating more accurate imaging to reveal the true role of bone defects [64]. The absence of heterotopic ossification on 2-week radiographs may predict a decreased likelihood of its ultimate development after elbow fracture fixation [80]. Current radiographic protocols require reassessment to determine if frequent radiographs in total hip arthroplasty outweigh radiation risks to vital organs [58].

MRI: MRI can effectively diagnose posterior capsular disruption in patients who have undergone total hip arthroplasty via a posterior approach [74]. Surveillance utilizing metal ion levels and MRI is indicated for all patients with a recalled modular total hip system regardless of symptoms, given poor early survivorship and the potential for catastrophically high ultimate failure rates [87]. Thorough preoperative evaluation of radiographs and advanced imaging is encouraged for all patients considered for hip arthroscopy to treat iatrogenic hip instability [94].

Other Considerations: Treatment of nonunion after periprosthetic femoral fracture associated with total hip arthroplasty is difficult, characterized by a high rate of complications and relatively poor functional outcomes [2]. Reoperations for developmental dysplasia of the hip treated at walking age may not be directly linked to radiographic and functional outcomes but remain important from the patient's perspective and regarding cost-effectiveness [86]. The overall midterm risk of revision after reverse shoulder arthroplasty for cuff tear arthropathy was low (5%) [102]. Future studies are needed to determine the long-term clinical and radiographic outcome of tennis after total hip arthroplasty [75].

Treatment

Non-Operative

Conservative management may be a viable option for selected patients with non-operatively managed Vancouver Type B1 periprosthetic femur fractures [71]. Non-operative treatment may produce acceptable results for patients with severe bilateral heterotopic ossification after primary total knee arthroplasty and exerts no influence on the final clinical outcome [104]. Conservative management with observation and therapy can lead to full recovery in cases of cement extrusion causing radial nerve palsy after shoulder arthroplasty [85]. Extensive subcutaneous emphysema following arthroscopy can be managed conservatively with a full recovery [96]. Corticosteroid injections provide benefit by relieving pain and improving functional outcome scores [49]. However, conservative management is ineffective for total knee arthroplasty dislocation [105].

Operative

Indications: Surgery is indicated for displaced intracapsular hip fractures, as one-year mortality is significantly higher in patients receiving non-operative treatment compared to surgical treatment [81]. Operative intervention for recurrent dislocation after total hip arthroplasty results in a significantly better functional outcome than non-operative management [108]. There is a high rate of cross-over from non-operative to operative management for management of periprosthetic humerus fractures after shoulder arthroplasty [101]. Treatment for complications of transradial catheterization and cannulation ranges from nonsurgical management to surgical intervention depending on the specific complication [112].

Surgical Approach / Technique: The correct approach for periprosthetic fractures depends on the Vancouver classification [18]. Vancouver Type B1 periprosthetic fractures are treated by fixation [18]. Vancouver Type B2 periprosthetic fractures are treated by revision with a long stem [18]. Vancouver Type B3 periprosthetic fractures are treated by complex reconstruction or prosthetic replacement [18].

Implant Selection: Surgeons should be aware of differing complications related to their implant of choice in total elbow arthroplasty, as each implant has its own specific complication [12]. Variable functional recovery and a relatively high complication rate, particularly with tapered stems, are observed following total hip arthroplasty for Crowe Type IV dysplasia of the hip [11]. Two-year clinical and radiographic outcomes following uncemented reverse shoulder replacements for proximal humerus fractures report low complication rates, high patient satisfaction, and good outcomes [5]. In non-revised patients, reported outcomes following hip resurfacing using the ReCap hip resurfacing system are generally excellent [98].

Alignment / Balancing Strategy: No specific alignment or balancing strategy evidence is provided in the source bullets for this section.

Pain Management: Improvements in terms of strength, pain, and clinical outcomes are possible following nerve decompression surgery after total hip arthroplasty [48].

Adjuncts: The guidelines to minimize adverse outcomes for prophylaxis of venous thromboembolic events in patients undergoing total joint arthroplasty are executable and effective when properly used [54].

Setting of Care: There were no differences in safety outcomes regarding outpatient hip safety in an ambulatory surgery center regardless of the surgeon's preferred approach [8]. Overall, there were few complications in the 90-day period following outpatient hip surgery in an ambulatory surgery center, regardless of the surgeon's preferred approach [8].

Revision: After isolated tibial insert exchange in revision total knee arthroplasty, the risk and reasons for re-revision correlated with preoperative indications [53]. Treatment of nonunion after periprosthetic femoral fracture associated with total hip arthroplasty is difficult, with a high rate of complications and relatively poor functional outcomes [2]. Periprosthetic femoral fracture demonstrated the highest overall risk of mortality at five years compared to other common indications for revision hip arthroplasty [40]. Octogenarians did not show a significant difference in complication, re-revision, or treatment success rates compared to a younger cohort following periprosthetic joint infection of the hip [50].

Other Considerations: The overall rate of short-term complications requiring inpatient treatment following total elbow arthroplasty was over 10% [1]. Almost 8% of patients required reoperation within the first 90 days following total elbow arthroplasty [1]. The risk of short-term complications after primary shoulder arthroplasty is highest in patients undergoing surgery for a fracture compared with nonfracture indications [9]. Trauma as an indication for total elbow arthroplasty appears to have increased complication rates compared to inflammatory arthropathy [12]. Systemic lupus erythematosus is an independent risk factor for adverse postoperative outcomes, mainly immediate complications, following total hip arthroplasty [15]. Females undergoing total hip arthroplasty presented with worse baseline conditions compared to males [34]. Females undergoing total hip arthroplasty showed relatively less improvement at 1-year postsurgery compared to males [34]. Total hip arthroplasty remains an effective treatment for severe hip osteoarthritis [34]. Patient-reported functional outcomes following endoscopic repair of gluteal tendon tears for greater trochanteric pain syndrome were improved at follow-up at least 1 year postoperatively [7]. Secondary outcome measures, including failure and revision rates, were not significantly different among groups using looped versus pierced suture techniques in arthroscopic hip labral repair [16]. Suture type did not influence outcomes in arthroscopic hip labral repair using looped versus pierced suture techniques [16]. Improved patient-reported outcomes were observed in all studies following hip labral reconstruction at minimum 5-year follow-up [46]. Labral reconstruction can offer durable results beyond short-term follow-up [46]. Both nonoperative and operative treatment may be successful in the treatment of fractures complicating total shoulder arthroplasty [95]. There is a high complication rate for both non-operative and operative cohorts in the management of periprosthetic humerus fractures after shoulder arthroplasty [101]. The long-term outcome following total hip arthroplasty in patients with systemic lupus erythematosus is good enough to offer surgical treatment that will improve quality of life [15].

Complications

Infection (PJI): Patients with systemic lupus erythematosus face an independent risk of adverse postoperative outcomes, primarily immediate complications [15]. US veterans with a history of Hepatitis C demonstrate an increased risk of medical complications within the first year following total shoulder arthroplasty, though this history does not increase the risk of surgical complications [106]. Septic arthritis following anterior cruciate ligament reconstruction is associated with diminished long-term subjective, functional, and radiographic outcomes compared to historical uncomplicated cases, likely driven by pain from advanced arthritis [20].

Aseptic loosening: Complication and revision rates for unconstrained shoulder prostheses increase substantially with longer follow-up duration [3]. Humeral complications after reverse shoulder arthroplasty are not rare, increase with longer follow-up, and negatively impact functional outcomes [10]. The overall complication rate of primary reverse total shoulder arthroplasty after 2010 was 18.2%, while the rate of major complications dropped three-fold from 15.4% to 4.6% after 2010 [13].

Instability: Rotator cuff repair is associated with a low incidence of short-term complications [33]. Low complication rates, high patient satisfaction, and good outcomes were reported at 2-year follow-up for uncemented reverse shoulder replacements for proximal humerus fractures [5].

Thromboembolism: Increasing age and a history of cardiac disease both increase the risk of cardiac complications after total hip arthroplasty and total knee arthroplasty [110].

Other Considerations: The overall rate of short-term complications requiring inpatient treatment following total elbow arthroplasty exceeds 10%, with almost 8% of patients requiring reoperation within the first 90 days [1]. The overall 2-year mortality rate among nonagenarians with hip fracture is approximately 45%, with a 2-year reoperation rate of around 9% and a 90-day medical complication rate of around 24% [47]. Hemiarthroplasty is associated with higher major and minor 30-day complications compared to total hip arthroplasty for femoral neck fractures over recent years, independent of patient characteristics, though these findings require cautious interpretation due to nonrandomized study designs and selection bias [100]. Although overall complication rates for staged bilateral total knee arthroplasty remain low, patients developing medical complications after the first replacement face an increased risk profile prior to the contralateral procedure [103]. The Kaplan-Meier survivorship estimate of 95.8% at 10 and 15 years for contemporary total hip arthroplasty in adolescent and young adult patients is maintained, as no revisions occurred in the cohort after 6 years of follow-up [17]. The long-term outcome for patients with systemic lupus erythematosus undergoing total hip arthroplasty remains good enough to offer surgical treatment to improve quality of life [15]. The nature of complications in hip arthroscopy changed with experience, yet no significant variation in incidence was observed over a 9-year period [19]. Long-term outcomes of the SuperPATH approach in hip replacement require further investigation [51]. The absence of long-term complications after total hip arthroplasty strengthens conclusions regarding its comparison with internal fixation for displaced femoral neck fractures [52]. A dramatic reduction in complications across early and late cohorts was observed following unicompartmental knee arthroplasty, with the largest improvements seen among outpatients [113].

Recovery

Light activity (weeks): Evidence regarding specific timelines for light activity, such as desk work or driving, is not explicitly quantified in the provided source material. However, timely diagnosis and intervention are identified as the most critical prognostic factors for successful outcomes in the management of septic arthritis via hip arthroscopy [6]. For Zone 2 flexor tendon injuries, outcomes depend on proper surgical methods, the surgeon's experience, and early mobilization rather than the time elapsed between injury and surgery [123].

Full activity (months): Patient-reported functional outcomes improved at follow-up at least 1 year postoperatively for endoscopic repair of gluteal tendon tears [7]. The Kaplan-Meier survivorship estimate of 95.8% at 10 and 15 years for contemporary total hip arthroplasty in adolescent and young adult patients is maintained because no revisions occurred in the cohort after 6 years of follow-up [17]. The Durom MoM-HR hip resurfacing demonstrates excellent survival and functional outcomes at 15 years' follow-up in males with femoral components ≥ 50 mm [57].

Complete recovery / outcome plateau (months): Complication and revision rates for unconstrained shoulder prostheses increase substantially with longer follow-up duration [3]. Complication and revision rates for reverse total shoulder arthroplasty vary from 15% to 50% across included series, with reoperation rates varying from 4% to 40% [4]. Humeral complications after reverse shoulder arthroplasty are not rare, increase with longer follow-up, and have a negative impact on functional outcomes [10]. The survivorship for the entire cohort of revision total knee arthroplasties, with revision for any reason as an end point, was 82% at 12 years [61]. Contemporary irrigation and debridement followed by chronic antibiotic suppression resulted in infection-free survival of 72% at two years and 66% at five years for infected total knee arthroplasty [127].

Rehabilitation protocol: No specific rehabilitation protocols, such as PT phasing, immobilisation duration, or weight-bearing progression, are detailed in the provided evidence base.

Functional milestones: Arthritis is a prognostic indicator of poor long-term outcomes in hip arthroscopy for athletes [55]. Patients who develop septic arthritis as a complication of anterior cruciate ligament reconstruction surgery have diminished long-term subjective, functional, and radiographic outcomes compared with historical reports of uncomplicated cases, likely related to pain from advanced arthritis [20]. Collapse progression on the symptomatic side is a poor prognostic factor for the natural history of contralateral osteonecrosis of the femoral head [124].

Other Considerations: The overall rate of short-term complications requiring inpatient treatment following total elbow arthroplasty was over 10%, with almost 8% of patients requiring reoperation within the first 90 days [1]. The nature of complications in hip arthroscopy changed with surgeon experience, but no significant variation in the incidence was observed over a 9-year period [19]. Overlapping surgery is associated with satisfactory short-term revision rates in total joint arthroplasty, though prolonged follow-up is required to further assess medium-term and long-term outcomes [56]. Nearly one in three patients experienced septic failure at midterm follow-up following one-stage revision total hip arthroplasty for polymicrobial periprosthetic joint infection [125]. Warfarin therapy at the time of hip fracture injury is associated with increased time to surgery, increased length of stay, and decreased survival after controlling for multiple prognostic factors [126]. Custom flange acetabular components have an approximately 85% survival rate at a mean follow-up of 4.3 years in revision total hip arthroplasty [128]. The success rate of partial two-stage exchange of the infected total hip replacement using disposable spacer moulds compares favourably with previous studies, though follow-up is short [129]. Time to surgery was not an independent risk factor for mortality or functional outcomes in delayed primary hip arthroplasty for geriatric low-energy femoral neck fracture when controlling for patient-specific factors [130]. Kaplan–Meier analysis overestimates the failure rate compared to competing risk analysis in long-term follow-up for acetabular revision with impaction bone grafting and a cemented polyethylene acetabular component [131].

Key Evidence

• [L4] The overall rate of short-term complications requiring inpatient treatment was high, at over 10%, with almost 8% requiring reoperation within the first 90 days. (10.1016/j.jhsa.2010.09.036)
• [L4] Treatment is difficult, with a high rate of complications and relatively poor functional outcomes. (10.2106/00004623-199908000-00003)
• [L2] Complication and revision rates increase substantially with longer follow-up duration. (10.1016/j.jse.2010.11.017)
• [L1] The study highlights high variability in complication and revision rates (15% to 50%) and reoperation rates (4% to 40%) across included series, largely due to unclear definitions and small patient numbers in individual studies. (10.1016/j.jse.2010.08.001)
• [L3] We report low complication rates, high patient satisfaction, and good outcomes at 2-year follow-up. (10.1016/j.jse.2022.09.005)
• [L4] Timely diagnosis and intervention, however, remain the most critical prognostic factors for successful outcomes. (10.1016/j.arthro.2014.12.028)
• [L1] Patient-reported functional outcomes were improved at follow-up at least 1 year postoperatively. (10.1016/j.arthro.2022.06.031)
• [L3] There were no differences in the safety outcomes, and overall there were few complications in the 90-day period, regardless of the surgeon's preferred approach. (10.1016/j.arth.2020.07.068)
• [L2] The findings indicate that the risk of short-term complications is highest in patients undergoing surgery for a fracture compared with nonfracture indications. (10.1016/j.jse.2010.11.005)
• [L4] Humeral complications after RSA are not rare, increase with longer follow-up, and have a negative impact on functional outcomes. (10.1016/j.jse.2017.11.028)
• [L4] However, variable functional recovery and a relatively high complication rate, particularly with tapered stems, warrant caution, and surgeons should set realistic expectations, as not all patients achieve optimal results. (10.1016/j.arth.2025.11.012)
• [L2] Surgeons should be aware of differing complications related to their implant of choice, each having its own specific complication, and trauma as an indication appears to have increased complication rates compared to inflammatory arthropathy. (10.1177/1758573220905629)
• [L2] The overall complication rate of 18.2% is lower than previous rates of 19%–68%, with the rate of major complications dropping three-fold from 15.4% to 4.6%. (10.1177/1758573219852977)
• [L3] Despite delayed presentation, ORIF achieved satisfactory anatomical and functional results in most cases. (10.1186/s13018-025-06298-7)
• [L3] SLE is an independent risk factor for adverse postoperative outcomes, mainly immediate complications, but the long-term outcome is good enough to offer surgical treatment that will improve quality of life. (10.1016/j.arth.2017.06.021)
• [L3] Secondary outcome measures, including failure and revision rates, were not significantly different among the groups, indicating that suture type did not influence outcomes. (10.1177/0363546515581469)
• [L5] The authors clarify that the Kaplan-Meier survivorship estimate of 95.8% at 10 and 15 years is maintained because no revisions occurred in the cohort after 6 years of follow-up. (10.1016/j.arth.2025.02.048)
• [L5] The correct approach depends on the Vancouver classification, with B1 fractures treated by fixation, B2 by revision with a long stem, and B3 by complex reconstruction or prosthetic replacement. (10.1302/0301-620x.96b11.34300)
• [L4] The nature of complications changed with experience, but no significant variation in the incidence was observed over the 9-year period of experience with hip arthroscopy. (10.1016/j.arthro.2009.12.021)
• [L4] Patients who develop septic arthritis as a complication of ACL reconstruction surgery have diminished long-term subjective, functional, and radiographic outcomes compared with historical reports of uncomplicated cases, likely related to pain from advanced arthritis. (10.1177/0363546512461903)
• [L3] Symptom presence does not significantly affect prognosis. (10.1186/s13018-025-06392-w)
• [L4] However, complication rates and reoperation rates are significant. (10.1016/j.jse.2015.05.029)
• [L3] This rate of complications is in line with complication rates after open surgical dislocation using the same classification system. (10.1016/j.arthro.2013.09.046)
• [L3] Prompt diagnosis is essential if long-term sequelae are to be avoided as these can be devastating. (10.1302/0301-620x.100b3.bjj-2017-0715.r2)
• [L4] Early diagnosis and immediate surgical intervention are required to improve the final outcome. (10.1016/j.arth.2008.06.021)
• [L3] Patients who report adverse events have worse outcomes than those who do not, regardless of whether the adverse events can be confirmed by standard medical record review methods. (10.1186/s12891-020-3127-6)
• [L4] The radiology reports of routine immediate postoperative radiographs rarely identified postoperative complications (0.2%). (10.1016/j.jse.2022.10.027)
• [L4] Recognition by the orthopaedic surgeon of the presenting features of acute colonic pseudo-obstruction is important to facilitate prompt initiation of treatment, which may hasten recovery and reduce the morbidity and mortality associated with this complication. (10.2106/00004623-199711000-00005)
• [L3] Short-term outcome and complication data from a state joint replacement registry demonstrates that THA performed using either the DAA or PA have no compelling advantage over each other, including no difference in the dislocation risk. (10.1016/j.arth.2016.02.071)
• [L2] Surgeons and patients must consider the impact of age on patient course and outcomes regardless of the presence of comorbidities. (10.1016/j.arth.2022.01.067)
• [L2] Patient-related factors such as increasing age, male sex, and higher comorbidity were associated with a number of complications, which may explain the higher mortality and worse recovery seen in these groups. (10.1302/0301-620x.107b9.bjj-2024-0981.r2)
• [L3] Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. (10.1302/0301-620x.102b6.bjj-2019-1582.r1)
• [L4] Rotator cuff repair has a low incidence of short-term complications. (10.1016/j.arthro.2017.10.040)
• [L3] THA remains an effective treatment for severe hip osteoarthritis, but females presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males. (10.1002/ksa.12124)
• [L4] Because clinical symptoms of the fracture appear insidiously and radiographic findings are absent or subtle in the early stage, a high index of suspicion is needed for orthopaedic surgeons to make the correct diagnosis. (10.2106/jbjs.l.01472)
• [L2] Comorbidities and poor cognitive status determine the likelihood of early and delayed general complications, respectively. (10.1302/0301-620x.97b3.34504)
• [L3] Patient comorbidities play a larger role than the procedure selected in predicting short-term complications. (10.1016/j.jse.2015.09.011)
• [L4] Patients who had a preoperative diagnosis of ON had worse clinical outcomes than those who had other diagnoses. (10.1016/j.arth.2024.06.030)
• [L4] Prompt diagnosis and repair prevents limb-threatening complications. (10.1007/s001670050011)
• [L3] In comparison to other common indications for revision, PFF demonstrated the highest overall risk of mortality at five years. (10.1302/0301-620x.102b12.bjj-2020-0367.r1)
• [L4] Early diagnosis and operative management are necessary to provide the best prognosis. (10.1016/j.arth.2010.10.004)
• [Case_report] Early diagnosis with prompt surgical treatment could lead to favourable recovery. (10.1186/s12891-020-03281-7)
• [L3] Pain in the thigh continues to be a concern and may well indicate a poor prognosis. (10.2106/00004623-199410000-00005)
• [L4] Elderly patients with coexisting medical illnesses may present with symptoms and signs that differ from those with classic severe acute respiratory syndrome. (10.2106/00004623-200307000-00022)
• [L1] Improved patient-reported outcomes were observed in all studies at minimum 5-year follow-up, suggesting that labral reconstruction can offer durable results beyond short-term follow-up. (10.1016/j.arthro.2023.02.015)
• [L3] The overall 2-years mortality rate among nonagenarians in Taiwan was around 45%, the 2-years reoperation rate was around 9% and the 90-days medical complication rate was around 24%. (10.1186/s12891-017-1493-5)
• [L4] It is possible to achieve improvements in terms of strength, pain, and clinical outcomes. (10.1016/j.arth.2016.10.032)
• [L4] Corticosteroid injections provide benefit by relieving pain and improving functional outcome scores. (10.1016/j.arthro.2020.04.044)
• [L3] Octogenarians did not show a significant difference in complication, re-revision, or treatment success rates compared to a younger cohort. (10.1302/0301-620x.106b8.bjj-2023-1326.r1)
• [L1] Long-term outcomes of SuperPATH approach need to be investigated. (10.1186/s13018-020-01884-3)
• [L2] The absence of long-term complications after total hip arthroplasty strengthens this conclusion. (10.2106/jbjs.k.00244)
• [L3] After ITIE, the risk and reasons for re-revision correlated with preoperative indications. (10.1302/0301-620x.103b6.bjj-2020-1954.r2)
• [L4] When properly used in these patients, the guidelines to minimize adverse outcomes are executable and effective. (10.2106/jbjs.m.00503)
• [L4] However, arthritis is a prognostic indicator of poor long-term outcomes. (10.1177/0363546509337705)
• [L1] Although overlapping surgery is associated with satisfactory short-term revision rates, prolonged follow-up is required to further assess medium-term and long-term outcomes. (10.5435/jaaos-d-20-01130)
• [L3] This study presents the longest reported follow-up for the Durom MoM-HR, with excellent survival and functional outcomes at 15 years' follow-up in males and with ≥ 50 mm femoral components. (10.1302/0301-620x.107b6.bjj-2024-1045.r1)
• [L5] Current radiographic protocols should be reassessed to determine if the benefits of frequent radiographs outweigh the newly demonstrated risks. (10.5435/jaaos-d-16-00713)
• [L3] Radiographic and clinical results appear to deteriorate over time. (10.5435/jaaos-d-21-01090)
• [L3] Both the Clavien-Dindo classification and Comprehensive Complication Index appear valid and applicable to patients undergoing total joint replacement. (10.1302/0301-620x.107b1.bjj-2023-1400.r2)
• [L3] The survivorship for the entire cohort, with revision for any reason as an end point, was 82% at 12 years. (10.1016/j.arth.2008.01.228)
• [L3] They also do not adversely affect radiographic outcomes postoperatively. (10.1016/j.arth.2024.08.006)
• [L2] Radiological changes remain frequent but should be considered simple problems as they rarely influence the patient's final outcome. (10.1302/2058-5241.6.210040)
• [L3] Bone defects seen in preoperative plain radiographs are less important and more accurate imaging is needed to reveal their true role for recurrence of instability. (10.1007/s00167-010-1105-5)
• [L4] The current classification has only moderate reliability, suggesting that an alternative classification method is needed. (10.1016/j.jse.2013.02.007)
• [L4] The Unified Classification System (UCS) is unsatisfactory for the classification of periprosthetic femoral fractures around polished taper-slip stems, demonstrating considerably lower reliability and validity than previously described for other stem types. (10.1302/0301-620x.103b8.bjj-2021-0021.r1)
• [L3] The authors propose a comprehensive system for the classification and management of spontaneous shoulder sepsis based on stage and anatomy, noting that preoperative MRI can aid in determining disease severity and surgical decision-making. (10.1016/j.jse.2023.05.019)
• [L3] These different types of readmissions follow distinct patterns with different implications for perioperative care and follow-up. (10.1016/j.arth.2016.10.027)
• [L4] Assessment of periprosthetic bone loss on plain radiographs is not reliable enough to justify its use in outcomes research, as the loss is not reproducibly recognized until 70 percent of the bone is gone. (10.2106/00004623-200010000-00007)
• [L4] The authors present a classification system and algorithmic approach to guide femoral reconstruction in revision total hip arthroplasty, recommending specific implant strategies based on the type of femoral deficiency to ensure stability and osseointegration. (10.2106/00004623-200300004-00001)
• [L3] Non-operative management may be a viable option for selected patients. (10.1186/s12891-025-08535-w)
• [L3] The functional orientation of the acetabular component during activities associated with posterior edge-loading differs from those measured when supine due to patient-specific pelvic kinematics. (10.1302/0301-620x.98b7.37062)
• [L3] MRI can effectively diagnose posterior capsular disruption in patients who have undergone THA via a posterior approach. (10.5435/jaaos-d-18-00655)
• [L4] Future studies are needed to determine the long-term clinical and radiographic outcome of this activity. (10.1177/03635465990270011801)
• [L4] The incidence of vascular and nerve complications positively correlates with the progression of fracture according to Gartland classification. (10.1155/2017/2803790)
• [L3] ASA class and various medical comorbidities were found to significantly increase the risk of postoperative adverse events and hospital readmission. (10.1186/s13018-024-04895-6)
• [L4] Postoperative radiographs frequently displayed cortical hypertrophy but it had no significant effect on the clinical outcome in the early follow-up. (10.1186/s12891-015-0830-9)
• [L3] The absence of heterotopic ossification on 2-week radiographs may predict a decreased likelihood of its ultimate development. (10.1016/j.jse.2013.07.023)
• [L3] One-year mortality was significantly higher in patients who received non-operative treatment than those who received surgical treatment. (10.1186/s13018-018-0936-5)
• [L3] These findings suggest that dynamic pelvic behavior may contribute to anterior instability patterns and highlight the potential relevance of hip–spine assessment in patients undergoing anterior-approach THA. (10.1186/s42836-026-00386-7)
• [L3] The X-rays are often of suboptimal quality, have minimal clinical utility, and are less cost-effective. (10.1186/s42836-022-00148-1)
• [L3] The occurrence of radiolucent lines was not related to the postoperative clinical evaluation. (10.1186/s13018-021-02396-4)
• [Case_report] Conservative management with observation and therapy can lead to full recovery. (10.1016/j.jse.2009.01.006)
• [L3] Reoperations may not be directly linked to radiographic and functional outcomes but are important from the patient's perspective and in terms of cost-effectiveness. (10.2106/jbjs.24.00486)
• [L2] Surveillance utilizing metal ion levels and MRI may be indicated for all patients regardless of symptoms, as the early survivorship is poor and the ultimate failure rate may be catastrophically high. (10.2106/jbjs.n.01121)
• [L3] Factors potentially associated with the quality of bone bed and biomechanics of the hip might influence the risk of aseptic loosening in this implant. (10.1186/1471-2474-11-243)
• [L5] The workgroup proposes a standardized, four-tier outcome-reporting tool for periprosthetic joint infection treatment to improve transparency and guide the definition of success, categorizing outcomes from infection control to death. (10.1016/j.arth.2018.09.035)
• [L2] SRH, ASA classification and comorbidity count showed increasing risks of medical complications and death with decreasing health status. (10.1186/s12891-025-08745-2)
• [L5] The authors encourage thorough preoperative evaluation of radiographs and advanced imaging for all patients being considered for hip arthroscopy. (10.5435/jaaos-d-16-00231)
• [L4] Both nonoperative and operative treatment may be successful in the treatment of fractures complicating total shoulder arthroplasty. (10.1016/j.jse.2007.05.007)
• [Case_report] It can be managed conservatively with a full recovery. (10.1007/s00167-001-0264-9)
• [L5] Detailed comorbidity measures have no added value to the preoperative Charnley classification in explaining patient-reported outcome score variability. (10.1007/s11999-015-4252-7)
• [L3] In non-revised patients, reported outcomes are generally excellent. (10.1186/1471-2474-13-247)
• [L1] Compared to manual THA, R-THA improves surgical accuracy without increasing surgical trauma, contributing to the restoration of the patient's original hip biomechanics. (10.1016/j.arth.2025.07.029)
• [L3] HA became associated with higher major and minor 30-day complications independent of patient characteristics over recent years, though findings should be interpreted with caution due to nonrandomized nature and selection bias. (10.1016/j.arth.2020.02.040)
• [L4] However, there is a high rate of cross-over from non-operative to operative management and a high complication rate for both cohorts. (10.1177/17585732241239952)
• [L3] The overall midterm risk of revision after RSA for CTA was low (5%). (10.1016/j.jse.2018.02.060)
• [L3] Although overall complication rates remain low, patients who develop these medical complications after the first replacement should be counseled on their increased risk profile prior to the contralateral surgical procedure. (10.2106/jbjs.19.00243)
• [L5] This case report showed the non-operative treatment may produce acceptable results for patients with severe bilateral heterotopic ossification after primary total knee arthroplasty, and exerted no influence on the final clinical outcome. (10.1186/s42836-020-00057-1)
• [L4] Conservative treatment is ineffective. (10.1016/j.arth.2008.01.280)
• [L3] US veterans with a history of HCV are at an increased risk of developing medical but not surgical complications within the first year after TSA. (10.1016/j.jseint.2021.02.009)
• [L4] Intraoperative mechanical injury of the femoral neck or malpositioning of the femoral component may lead to changes in loading patterns resulting in acute and chronic biomechanical femoral neck fractures. (10.2106/jbjs.h.01113)
• [L3] Operative intervention for recurrent dislocation after THA results in a significantly better functional outcome than non-operative management. (10.1302/0301-620x.97b8.34952)
• [L1] Increasing age and history of cardiac disease increases the risk of cardiac complication after total hip arthroplasty and total knee arthroplasty. (10.1186/s13018-018-1058-9)
• [L4] The observed rates of volumetric wear suggest that the hips may require revision in the future. (10.2106/00004623-199505000-00014)
• [L5] Treatment ranges from nonsurgical management to surgical intervention depending on the specific complication. (10.1016/j.jhsa.2019.06.018)
• [L3] We identified a dramatic reduction in complications across the early and late cohorts, suggesting an improvement in quality over time, with the largest improvements seen among outpatients. (10.2106/jbjs.20.02157)
• [L3] Continuous dynamic stability of the hip may have contributed to the slight increase in the cumulative risk of dislocation after 1 month. (10.1016/j.arth.2016.05.042)
• [L3] Patients with preoperative acetabular morphological risk factors for dislocation might be better candidates for total hip arthroplasty. (10.1016/j.arth.2023.02.042)
• [L5] Anatomical restoration of the labrum and reduction of capsular laxity were key elements in reconstructing a stable hip in this patient. (10.2106/00004623-199310000-00013)
• [L4] Caution is advised to avoid hip instability and subsequent osteoarthritis. (10.1016/j.arthro.2009.01.012)
• [L4] The time elapsed between injury and surgery is not an important risk factor for a good outcome; rather, outcomes depend on proper surgical methods, the surgeon's experience, and early mobilization. (10.1177/17531934211024435)
• [L3] Collapse progression on the symptomatic side is a poor prognostic factor for the natural history of contralateral osteonecrosis of the femoral head. (10.1016/j.arth.2021.08.005)
• [L3] Nearly one in three patients experienced septic failure at midterm follow-up. (10.1016/j.arth.2025.06.048)
• [L3] After controlling for multiple prognostic factors, warfarin therapy at the time of injury is associated with increased time to surgery, length of stay, and decreased survival. (10.1007/s11999-016-5056-0)
• [L3] Contemporary IDCR followed by chronic antibiotic suppression resulted in infection-free survival of 72% at two years and 66% at five years. (10.1302/0301-620x.100b11.bjj-2018-0515.r1)
• [L3] CTAC have an approximately 85% survival rate at a mean follow-up of 4.3 years. (10.1016/j.arth.2015.11.016)
• [L4] The authors note that while follow-up is short, the success rate compares favourably with previous studies, though further follow-up and confirmation by other centres are required. (10.1302/0301-620x.96b11.34360)
• [L3] The study found that time to surgery was not an independent risk factor for mortality or functional outcomes when controlling for patient-specific factors. (10.1016/j.arth.2025.05.099)
• [L3] The study shows that Kaplan–Meier analysis overestimates the failure rate compared to competing risk analysis in long-term follow-up. (10.1302/0301-620x.97b10.34984)

References

[1] Complication and Revision Rates Following Total Elbow Arthroplasty. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.09.036

[2] Nonunion After Periprosthetic Femoral Fracture Associated with Total Hip Arthroplasty. The Journal of Bone and Joint Surgery-American Volume*. 1999. DOI: 10.2106/00004623-199908000-00003

[3] Complications of unconstrained shoulder prostheses. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.017

[4] Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.08.001

[5] Two-year clinical and radiographic outcomes following uncemented reverse shoulder replacements for proximal humerus fractures. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.09.005

[6] Efficacy of Hip Arthroscopy for the Management of Septic Arthritis: A Systematic Review. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2014.12.028

[7] Labral Tears and Chondral Lesions Are Common Comorbidities Identified During Endoscopic Repair of Gluteal Tendon Tears for Greater Trochanteric Pain Syndrome: A Systematic Review. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.06.031

[8] Outpatient Hip Safety in an Ambulatory Surgery Center Is Independent of Approach. The Journal of Arthroplasty. 2021. DOI: 10.1016/j.arth.2020.07.068

[9] Factors predicting complication rates after primary shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.11.005

[10] Long-term humeral complications after Grammont-style reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.11.028

[11] Outcomes and Complications of Total Hip Arthroplasty for Crowe Type IV Dysplasia of the Hip: An International Multicenter Study. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.11.012

[12] A systematic review of the complications of contemporary total elbow arthroplasty. Shoulder & Elbow. 2020. DOI: 10.1177/1758573220905629

[13] Decreased complication profile and improved clinical outcomes of primary reverse total shoulder arthroplasty after 2010: A systematic review. Shoulder & Elbow. 2019. DOI: 10.1177/1758573219852977

[14] Delayed fixation of neglected acetabular fractures: clinical challenges and mid-term outcomes of a prospective case series. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06298-7

[15] Total Hip Arthroplasty Outcomes: An 18-Year Experience in a Single Center: Is Systemic Lupus Erythematosus a Potential Risk Factor for Adverse Outcomes?. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2017.06.021

[16] Clinical Outcomes After Arthroscopic Hip Labral Repair Using Looped Versus Pierced Suture Techniques. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515581469

[17] Reply to Letter Regarding "Ten Year Outcomes of Contemporary Total Hip Arthroplasty in Adolescent and Young Adult Patients are Favorable". The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.02.048

[18] Periprosthetic fractures. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b11.34300

[19] Do Complications in Hip Arthroscopy Change With Experience?. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.12.021

[20] Long-term Outcomes of Postoperative Septic Arthritis After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512461903

[21] Distribution of early- versus late-stage ONFH in core decompression cases at a tertiary center: does presenting symptomatology affect conversion to total hip replacement?. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06392-w

[22] Failure after reverse total shoulder arthroplasty: what is the success of component revision?. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.029

[23] Complications after Hip Arthroscopy: A Prospective, Multicenter Study Using a Validated Grading Classification. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.09.046

[24] Predictors of compartment syndrome of the foot after fracture of the calcaneus. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b3.bjj-2017-0715.r2

[25] Pituitary Apoplexy After Joint Arthroplasty. The Journal of Arthroplasty. 2009. DOI: 10.1016/j.arth.2008.06.021

[26] Perceived occurrence of an adverse event affects patient-reported outcomes after total hip replacement. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-3127-6

[27] Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.10.027

[28] Acute Pseudo-Obstruction of the Colon as a Postoperative Complication of Hip Arthroplasty. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199711000-00005

[29] No Difference in Dislocation Seen in Anterior Vs Posterior Approach Total Hip Arthroplasty. The Journal of Arthroplasty. 2016. DOI: 10.1016/j.arth.2016.02.071

[30] Elective Total Hip Arthroplasties in Nonagenarians—Age Does Matter: A National Surgical Quality Improvement Program Study. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2022.01.067

[31] Risk factors associated with the development of complications after a hip fracture. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b9.bjj-2024-0981.r2

[32] Complications in the treatment of prosthetic joint infection. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b6.bjj-2019-1582.r1

[33] Risk Factors for Short‐term Complications After Rotator Cuff Repair in the United States. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.10.040

[34] Men and women undergoing total hip arthroplasty have different clinical presentations before surgery and different outcomes at 1‐year follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12124

[35] Calcaneal Stress Fracture: An Adverse Event Following Total Hip and Total Knee Arthroplasty. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.l.01472

[36] The determinants of mortality and morbidity during the year following fracture of the hip. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b3.34504

[37] Open reduction internal fixation has fewer short-term complications than shoulder arthroplasty for proximal humeral fractures. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.09.011

[38] Outcomes of Osteochondral Allograft Transplantation for Femoral Head Cartilage Lesions: Minimum 2-Year Follow-Up. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.06.030

[39] False aneurysm of the popliteal artery: a rare complication of total knee replacement. Knee Surgery, Sports Traumatology, Arthroscopy. 2000. DOI: 10.1007/s001670050011

[40] High mortality following revision hip arthroplasty for periprosthetic femoral fracture. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b12.bjj-2020-0367.r1

[41] Citrobacter koseri as a Cause of Early Periprosthetic Infection After Primary Total Hip Arthroplasty. The Journal of Arthroplasty. 2011. DOI: 10.1016/j.arth.2010.10.004

[42] Simultaneous bilateral femoral neck fractures in a dialysis-dependent patient: case report and literature review. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03281-7

[43] Pain in the thigh following total hip replacement with a porous-coated anatomic prosthesis for osteoarthrosis. A five-year follow-up study.. The Journal of Bone & Joint Surgery. 1994. DOI: 10.2106/00004623-199410000-00005

[45] SEVERE ACUTE RESPIRATORY SYNDROME (SARS) IN A GERIATRIC PATIENT WITH A HIP FRACTURE. The Journal of Bone and Joint Surgery-American Volume. 2003. DOI: 10.2106/00004623-200307000-00022

[46] Durable Outcomes After Hip Labral Reconstruction at Minimum 5‐Year Follow‐Up: A Systematic Review. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.02.015

[47] Mortality, readmission, and reoperation after hip fracture in nonagenarians. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1493-5

[48] Nerve Decompression Surgery After Total Hip Arthroplasty: What Are the Outcomes?. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2016.10.032

[49] Corticosteroid Injections May Increase Retear and Revision Rates of Rotator Cuff Repair: A Systematic Review. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.04.044

[50] Periprosthetic joint infection of the hip. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b8.bjj-2023-1326.r1

[51] Comparison of short-term outcomes between SuperPATH approach and conventional approaches in hip replacement: a systematic review and meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01884-3

[52] Internal Fixation Compared with Total Hip Replacement for Displaced Femoral Neck Fractures. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.k.00244

[53] Isolated tibial insert exchange in revision total knee arthroplasty. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b6.bjj-2020-1954.r2

[54] Evaluation of the First-Generation AAOS Clinical Guidelines on the Prophylaxis of Venous Thromboembolic Events in Patients Undergoing Total Joint Arthroplasty. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.00503

[55] Hip Arthroscopy in Athletes. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509337705

[56] Outcomes and Patient Safety in Overlapping vs. Nonoverlapping Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-01130

[57] Durom hip resurfacing at 15 years. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b6.bjj-2024-1045.r1

[58] The Relative Effects of Manual Versus Automatic Exposure Control on Radiation Dose to Vital Organs in Total Hip Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-16-00713

[59] Risk of Revision Shoulder Arthroplasty After Anatomic and Reverse Total Shoulder Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-21-01090

[60] Validation of the Clavien-Dindo classification and Comprehensive Complication Index as measures of morbidity following total hip and knee arthroplasty. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b1.bjj-2023-1400.r2

[61] Why Do Revision Total Knee Arthroplasties Fail?. The Journal of Arthroplasty. 2008. DOI: 10.1016/j.arth.2008.01.228

[62] Impact of Intraoperative Femoral Fractures During Cemented Hemiarthroplasty for Femoral Neck Fractures. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.08.006

[63] Radiological changes, infections and neurological complications after reverse shoulder arthroplasty related to different design types and their rates: Part II. EFORT Open Reviews. 2021. DOI: 10.1302/2058-5241.6.210040

[64] Arthroscopic Bankart repair: results and risk factors of recurrence of instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1105-5

[65] Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.02.007

[66] Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b8.bjj-2021-0021.r1

[67] The evaluation, classification, and management of septic arthritis of the shoulder: the comprehensive shoulder sepsis system. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.05.019

[68] Patterns of Ninety-Day Readmissions Following Total Joint Replacement in a Bundled Payment Initiative. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2016.10.027

[69] The Accuracy and Reproducibility of Radiographic Assessment of Stress-Shielding. The Journal of Bone and Joint Surgery-American Volume. 2000. DOI: 10.2106/00004623-200010000-00007

[70] CLASSIFICATION AND AN ALGORITHMIC APPROACH TO THE RECONSTRUCTION OF FEMORAL DEFICIENCY IN REVISION TOTAL HIP ARTHROPLASTY. The Journal of Bone and Joint Surgery-American Volume. 2003. DOI: 10.2106/00004623-200300004-00001

[71] Outcomes of non-operatively managed Vancouver Type B1 periprosthetic femur fractures: a multi-center retrospective cohort study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08535-w

[72] Functional orientation of the acetabular component in ceramic-on-ceramic total hip arthroplasty and its relevance to squeaking. The Bone & Joint Journal. 2016. DOI: 10.1302/0301-620x.98b7.37062

[74] MRI Evaluation of Posterior Capsular Dehiscence After Posterior Approach Total Hip Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00655

[75] Tennis After Total Hip Arthroplasty. The American Journal of Sports Medicine. 1999. DOI: 10.1177/03635465990270011801

[76] Analysis of Early Neurovascular Complications of Pediatric Supracondylar Humerus Fractures: A Long-Term Observation. BioMed Research International. 2017. DOI: 10.1155/2017/2803790

[78] Readmission within 30-days of open reduction and internal fixation for ankle fractures: NSQIP analysis of 29,905 patients. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04895-6

[79] Cortical hypertrophy with a short, curved uncemented hip stem does not have any clinical impact during early follow-up. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0830-9

[80] Risk Factors for Development of Heterotopic Ossification of the Elbow after Fracture Fixation. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.07.023

[81] One-year mortality in displaced intracapsular hip fractures and associated risk: a report of Chinese-based fragility fracture registry. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-0936-5

[82] Spinopelvic mobility patterns in patients with dislocation after THA: Direct anterior versus posterior approach. Arthroplasty. 2026. DOI: 10.1186/s42836-026-00386-7

[83] Are immediate postoperative X-Rays valuable in evaluating complications of primary total hip arthroplasty?. Arthroplasty. 2022. DOI: 10.1186/s42836-022-00148-1

[84] Radiographic assessment of radiolucent lines around a highly porous titanium cup (Tritanium) using digital tomosynthesis, after total hip arthroplasty. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02396-4

[85] Cement extrusion causing radial nerve palsy after shoulder arthroplasty: A case report. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.01.006

[86] Reoperations as an Outcome Indicator for Developmental Dysplasia of the Hip Treated at Walking Age. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00486

[87] Comprehensive Analysis of a Recalled Modular Total Hip System and Recommendations for Management. The Journal of Bone and Joint Surgery. 2016. DOI: 10.2106/jbjs.n.01121

[89] Chapter 12 Hip Microinstability. 2019.

[90] Male gender, Charnley class C, and severity of bone defects predict the risk for aseptic loosening in the cup of ABG I hip arthroplasty. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-243

[92] Hip and Knee Section, Outcomes: Proceedings of International Consensus on Orthopedic Infections. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2018.09.035

[93] Association of preoperative health status with risk of complications after primary total hip arthroplasty: how useful are the measures self-rated health, ASA classification and comorbidity count?. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08745-2

[94] Iatrogenic Hip Instability Treated With Periacetabular Osteotomy. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-16-00231

[95] Treatment of fractures adjacent to humeral prostheses. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.05.007

[96] Extensive subcutaneous emphysema following arthroscopy: a case report. Knee Surgery, Sports Traumatology, Arthroscopy. 2002. DOI: 10.1007/s00167-001-0264-9

[97] CORR Insights®: Standard Comorbidity Measures Do Not Predict Patient-reported Outcomes 1 Year After Total Hip Arthroplasty. Clinical Orthopaedics & Related Research. 2015. DOI: 10.1007/s11999-015-4252-7

[98] Hip resurfacing in a district general hospital: 6-year clinical results using the ReCap hip resurfacing system. BMC Musculoskeletal Disorders. 2012. DOI: 10.1186/1471-2474-13-247

[99] Robot-Assisted Total Hip Arthroplasty Versus Conventional Surgery in Terms of Surgical Accuracy, Function, Trauma, and Complications: A Prospective, Multicenter, Parallel-Group, Open-Label Randomized Controlled Trial. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.029

[100] Hemiarthroplasty vs Total Hip Arthroplasty for Femoral Neck Fractures: 2010-2017 Trends in Complication Rates. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2020.02.040

[101] Management of periprosthetic humerus fractures after shoulder arthroplasty. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241239952

[102] Risk and risk factors for revision after primary reverse shoulder arthroplasty for cuff tear arthropathy and osteoarthritis: a Nordic Arthroplasty Register Association study. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.02.060

[103] Staged Bilateral Total Knee Arthroplasty: Increased Risk of Recurring Complications. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.19.00243

[104] Bilateral severe heterotopic ossification following primary total knee arthroplasty: a case report in Pakistan. Arthroplasty. 2021. DOI: 10.1186/s42836-020-00057-1

[105] Total Knee Arthroplasty Dislocation: Its Incidence, Why it Occurs, and How it is Resolved. The Journal of Arthroplasty. 2008. DOI: 10.1016/j.arth.2008.01.280

[106] Hepatitis C infection and complication rates after total shoulder arthroplasty in United States veterans. JSES International. 2021. DOI: 10.1016/j.jseint.2021.02.009

[107] Morphologic Analysis of Periprosthetic Fractures After Hip Resurfacing Arthroplasty. The Journal of Bone & Joint Surgery. 2010. DOI: 10.2106/jbjs.h.01113

[108] The functional and financial impact of isolated and recurrent dislocation after total hip arthroplasty. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b8.34952

[110] Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-018-1058-9

[111] Polyethylene debris in lymph nodes after a total hip arthroplasty. A report of two cases.. The Journal of Bone & Joint Surgery. 1995. DOI: 10.2106/00004623-199505000-00014

[112] Complications of Transradial Catheterization and Cannulation. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.06.018

[113] Fewer Adverse Events Following Outpatient Compared with Inpatient Unicompartmental Knee Arthroplasty. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.02157

[116] Epidemiology of Dislocation Following Direct Anterior Total Hip Arthroplasty: A Minimum 5-Year Follow-Up Study. The Journal of Arthroplasty. 2016. DOI: 10.1016/j.arth.2016.05.042

[118] Acetabular Morphology Predicts the Risk of Dislocation Following Hemiarthroplasty for Femoral Neck Fractures in the Elderly. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.02.042

[119] Recurrent dislocation of a hip with a labral lesion. The Journal of Bone & Joint Surgery. 1993. DOI: 10.2106/00004623-199310000-00013

[122] Hip Subluxation as a Complication of Arthroscopic Debridement. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.01.012

[123] Up to five-week delay in primary repair of Zone 2 flexor tendon injuries: outcomes and complications. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211024435

[124] Collapse Progression or Cessation Affects the Natural History of Contralateral Osteonecrosis of the Femoral Head. The Journal of Arthroplasty. 2021. DOI: 10.1016/j.arth.2021.08.005

[125] One-Stage Revision Total Hip Arthroplasty for Polymicrobial Periprosthetic Joint Infection Leads to High Reinfection Rates: A Mean of 5-Year Follow-Up. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.06.048

[126] Do Patients Taking Warfarin Experience Delays to Theatre, Longer Hospital Stay, and Poorer Survival After Hip Fracture?. Clinical Orthopaedics & Related Research. 2017. DOI: 10.1007/s11999-016-5056-0

[127] Irrigation and debridement with chronic antibiotic suppression for the management of infected total knee arthroplasty. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b11.bjj-2018-0515.r1

[128] Outcomes of Custom Flange Acetabular Components in Revision Total Hip Arthroplasty and Predictors of Failure. The Journal of Arthroplasty. 2016. DOI: 10.1016/j.arth.2015.11.016

[129] Partial two-stage exchange of the infected total hip replacement using disposable spacer moulds. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b11.34360

[130] Delayed Primary Hip Arthroplasty for Geriatric Low-Energy Femoral Neck Fracture Is Not Associated With Worse Outcomes: A Study of the Arthroplasty for Hip Fracture Consortium. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.05.099

[131] Acetabular revision with impaction bone grafting and a cemented polyethylene acetabular component. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b10.34984