Clinical Decision-Making in Total Hip Arthroplasty: Evaluating Indications and Alternatives
DOI:
https://doi.org/10.54097/vnvt8725Keywords:
Total hip replacement, osteoarthritis, alternative treatments.Abstract
Total hip arthroplasty (THA) is widely regarded as the gold standard for the treatment of end-stage hip disease, yet not all patients require or are suitable for immediate surgery. For those with mild to moderate disease, particularly younger and more active individuals, alternative strategies such as hip arthroscopy, osteotomy, and intra-articular injections can provide symptomatic relief, delay disease progression, and preserve native joint function whenever possible. These approaches have gained attention in recent years as they may postpone the need for THA and reduce the risk of early revision in high-demand patients. However, for advanced disease with irreversible structural damage, THA remains the definitive option. Optimal decision-making requires careful integration of clinical symptoms, radiographic evidence, patient age, comorbidity profile, personal preference, surgical techniques, and perioperative risk assessment. This review aims to systematically summarize the indications and limitations of alternative treatments, explore the criteria for THA candidacy and the selection of surgical timing, and evaluate the contribution of predictive models and decision-support tools to clinical decision-making, with the goal of providing references for individualized management.
Downloads
References
[1] Bjerre-Bastos J, Varnum C, Overgaard S. The indication for total hip arthroplasty and its durability. Ugeskrift for Laeger, 2024, 186(33): V03240219.
[2] Fan Y, Xu Q, Jin G, et al. The cost of total hip arthroplasty: compare the hospitalization costs of national centralized procurement and national volume-based procurement. Frontiers in Public Health, 2024, 12: 1383308.
[3] Saracco M, Ciriello V, D’Angelo F, et al. Do prior intra-articular injections impact on the risk of periprosthetic joint infection in patients undergoing total hip arthroplasty? A meta-analysis of the current evidences with a focus on the timing of injection before surgery. EFORT Open Reviews, 2023, 8(6): 459–467.
[4] Li C, Qian D, Wang B, et al. Clinical practice guideline for surgical approach selection in total hip arthroplasty in China (2021 edition). Chinese Journal of Joint Surgery, 2021, 15(6): 651–659.
[5] Li G, Yang L, Li Y, et al. Application status and prospects of 3D printing technology in artificial hip replacement. Chinese Journal of Bone and Joint, 2018, 7(12): 937–941.
[6] Erivan R, Villatte G, Dartus J, et al. Progression and projection for hip surgery in France, 2008–2070: epidemiologic study with trend and projection analysis. Orthopaedics & Traumatology, Surgery & Research, 2019, 105(7): 1227–1235.
[7] Siddiqi A, Levine B R, Springer B D, et al. Highlights of the 2021 American Joint Replacement Registry Annual Report. Arthroplasty Today, 2022, 13: 205–207.
[8] Da Costa B R, Pereira T V, Saadat P, et al. Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis. BMJ, 2021, 375: n2321.
[9] Berteau J P. Systematic narrative review of modalities in physiotherapy for managing pain in hip and knee osteoarthritis: a review. Medicine, 2024, 103(39): e38225.
[10] Pereira T V, Saadat P, Bobos P, et al. Effectiveness and safety of intra-articular interventions for knee and hip osteoarthritis based on large randomized trials: a systematic review and network meta-analysis. Osteoarthritis and Cartilage, 2025, 33(2): 207–217.
[11] Wasilczyk C, Wasilczyk B. Nanosurgery and bioengineered regenerative protocols for the treatment of hip osteoarthritis: a double-blind randomized controlled trial as an alternative to surgical hip replacement. Biomedicines, 2025, 13(4): 987.
[12] Jamil M, Dandachli W, Noordin S, et al. Hip arthroscopy: indications, outcomes and complications. International Journal of Surgery, 2018, 54(Pt B): 341–344.
[13] Lameire D L, Pathak A, Hu S Y, et al. The impact of hip arthroscopy on the progression of hip osteoarthritis in patients with femoroacetabular impingement syndrome: a systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine, 2025, 13(4): 23259671251326116.
[14] Umer M, Quadri T A, Rashid R H, et al. Ilizarov hip reconstruction osteotomy – a review. International Journal of Surgery, 2018, 54(Pt B): 351–355.
[15] Rizkalla J M, Gladnick B P, Bhimani A A, et al. Triaging total hip arthroplasty during the COVID-19 pandemic. Current Reviews in Musculoskeletal Medicine, 2020, 13(4): 416–424.
[16] Wang Y, Jiang Q, Long H, et al. Trends and benefits of early hip arthroplasty for femoral neck fracture in China: a national cohort study. International Journal of Surgery, 2024, 110(3): 1347–1355.
[17] Pallante G D, Statz J M, Milbrandt T A, et al. Primary total hip arthroplasty in patients 20 years old and younger. The Journal of Bone and Joint Surgery. American Volume, 2020, 102(6): 519–525.
[18] Li M, Glassman A H. What is new in hip replacement. The Journal of Bone and Joint Surgery. American Volume, 2020, 102(18): 1572–1580.
[19] Kunze K N, Karhade A V, Sadauskas A J, et al. Development of machine learning algorithms to predict clinically meaningful improvement for the patient-reported health state after total hip arthroplasty. The Journal of Arthroplasty, 2020, 35(8): 2119–2123.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
