Open research questions in Orthopaedic implants and arthroplasty
411 gap statements mined from Orthopaedic implants and arthroplasty papers in our 7.9M-paper local library, which holds 2,370 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.
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What the literature leaves open
The lack of established protocols for managing liver transplant recipients undergoing revision total hip arthroplasty. The need for individualized multidisciplinary management to optimize clinical outcomes in this complex patient population.
Further studies are needed to investigate the factors associated with navigation errors. The comparison of the two navigation systems in a larger population is necessary. Investigation of the long-term outcomes of the patients who underwent THA using the two navigation systems is required.
Accuracy of acetabular cup installation angles using two augmented reality navigation systems: computed tomography-based and noninvasive portable systems in total hip arthroplasty · 2026 · DOIThe study is subject to selection bias as it only includes patients with at least one completed patient-reported outcome measure. The study faces challenges in deriving minimal clinically important difference thresholds due to the lack of anchor-based methods in registry data.
Patient-reported outcome measure comparison of two cemented primary total hip arthroplasty implant combinations for osteoarthritis: a regional New Zealand study · 2026 · DOIThere is a lack of evidence on the outcomes of conversion total hip arthroplasty via different surgical approaches. The study aims to fill this gap by examining the outcomes of conversion total hip arthroplasty via anterior and posterior approaches, as well as robotic assistance.
Anterior approach and robotic assistance associated with shorter operative times and lower transfusion requirements in conversion total hip arthroplasty · 2026 · DOICurrent training models for screw fixation have limitations. The difference between cortical and trabecular bone is not well appreciated or easily replicated with current models.
Mechanical validation of 3D-printed orthopaedic surrogate models for screw insertion training · 2026 · DOIThe need for a reliable and effective treatment option for revision hip arthroplasty. The lack of studies evaluating the mid-term outcomes of using modular cementless long stems in revision hip arthroplasty.
Radiological stability and functional performance of cementless modular long stems in revision hip arthroplasty: a minimum 4-year follow-up single-center experience · 2026 · DOILack of investigation into the complications associated with underweight patients undergoing total hip arthroplasty. Limited understanding of the risks for low-BMI patients. Need for tailored perioperative strategies for low-BMI patients.
The effects of TiO2 particles on the macrophage-derived chitinase family members CHIT1 and YKL-40 remain poorly understood. There is a need to investigate the impact of TiO2 particles on the expression of CHIT1 and YKL-40 in human macrophages. The study seeks to address this knowledge gap by exploring the effects of TiO2 particles on human macrophages.
TiO2 particles induce CHIT1 and YKL-40 in human macrophages: implications for implant-associated inflammation · 2026 · DOIThe researchers mention the need to balance the trade-off between wear resistance and other material properties.
Tribological and Low Temperature Behavior of ZTA Composites with Graphene Oxide Addition Reinforced with Ductile Particles · 2025 · DOIThe gap in existing materials for biomedical applications is the need for improved wear resistance. The paper identifies the need for developing new materials with enhanced tribological properties.
Tribological and Low Temperature Behavior of ZTA Composites with Graphene Oxide Addition Reinforced with Ductile Particles · 2025 · DOIThe impact of the direct anterior approach on femoral component survival is not well understood. Prior studies have reported conflicting results, and there is a need for large-scale analyses to address this gap. The study aims to provide a comprehensive analysis of the association between the direct anterior approach and femoral stem survival.
Is direct anterior approach associated with a compromise of femoral stem survival after total hip arthroplasty? A regional registry-based analysis · 2026 · DOIThe optimal method of cup fixation in total hip arthroplasty remains unclear, particularly in elderly patients. Prior studies have not adequately addressed the comparative risk of revision between cemented and uncemented acetabular cups.
Association between cemented and uncemented cups and risk of revision in patients aged 65 years or older following primary total hip arthroplasty: a study of 310,515 patients from the Nordic Arthroplasty Register Association · 2026 · DOIImplants account for a substantial portion of procedural expenses, yet trends in TSA implant pricing relative to total costs, hospital and physician reimbursement, and patient out-of-pocket (OOP) spending remain poorly characterized.
Implant prices and physician reimbursement have declined more than total costs and hospital payments in total shoulder arthroplasty · 2026 · DOIThis inconsistency leads to variability in reported outcomes, with limited studies focusing on post-surgical hypersensitivity in patients.
Metal sensitivity in total joint arthroplasty: None of the current diagnostic tests are reliable, sensitive and specific enough to guide treatment decisions! · 2025 · DOIClinically, both cemented and press-fit fixations are used; however, there is no consensus biomechanical guideline to determine the optimal fixation strategy.
Polyethylene (PE) wear after shoulder arthroplasty is a rarely reported cause of failure.
Further studies, including multicentre case series, are needed to better define optimal perioperative management and long-term outcomes in this high-risk…
Exclusion criteria included any non-elective surgery, bilateral planned THA, severe hip dysplasia requiring subsequent THA and femoral osteotomy, any form of revision THA, ankylosing spondylitis, pre-existing spinal fusion at any level, and neurological preexisting conditions - The investigation had a limited sample size of 197 patients - The study only included patients who underwent elective primary unilateral…
Changes in low back pain, global sagittal alignment, and spinopelvic parameters following primary total hip arthroplasty: results of a prospective observational study with two-year follow-up · 2026 · DOIFurther research into the alignment-related factors contributing to reduced LBP after THA - Investigation into changes affecting sagittal spinal and spinopelvic parameters - Research into the optimal sequence of surgical intervention in patients with coexisting hip and spine…
Changes in low back pain, global sagittal alignment, and spinopelvic parameters following primary total hip arthroplasty: results of a prospective observational study with two-year follow-up · 2026 · DOISelection bias due to inclusion limited to patients captured by the registry, - Patients without any PROMs may differ systematically from responders, - The proportion of missing PROMs was relatively small but may introduce bias, - The study is subject to selection bias, - Inclusion was limited to patients with at least one completed…
Patient-reported outcome measure comparison of two cemented primary total hip arthroplasty implant combinations for osteoarthritis: a regional New Zealand study · 2026 · DOIInvestigating the effect of other infill patterns on ST, - Investigating the effect of other factors, such as screw thread depth and quality of bone, on ST, - Developing more advanced 3D-printed surrogates that can replicate complex anatomical features and pathological…
Mechanical validation of 3D-printed orthopaedic surrogate models for screw insertion training · 2026 · DOISmall sample size of 45 patients, - Limited follow-up period of three months, - No comparison with a control…
Correlation between sagittal plane deformities of the hip and spinopelvic alignment in advanced hip arthritis patients undergoing total hip arthroplasty: a prospective observational study · 2026 · DOIFurther studies are needed to investigate the long-term effects of THA on spinopelvic mechanics, - Research on the development of more accurate methods for predicting postoperative spinopelvic alignment is necessary, - Investigation of the relationship between spinopelvic mechanics and clinical outcomes in other patient…
Correlation between sagittal plane deformities of the hip and spinopelvic alignment in advanced hip arthritis patients undergoing total hip arthroplasty: a prospective observational study · 2026 · DOIThe study used a limited number of patients, - The study only investigated the effects of TiO2 particles on human macrophages, - The study did not investigate the effects of other types of implant-derived…
TiO2 particles induce CHIT1 and YKL-40 in human macrophages: implications for implant-associated inflammation · 2026 · DOIBarriers to the widespread adoption of AI and robotics in THA include cost-effectiveness, - Regulatory challenges can delay the availability of innovative tools and hinder their adoption, - The implementation of these technologies requires extensive training for surgeons and operating room staff, - Limitations, particularly among elderly populations with lower adaptability to technology, underscore the need…
The Role of Artificial Intelligence and Emerging Technologies in Advancing Total Hip Arthroplasty · 2025 · DOI
Most-cited papers in Orthopaedic implants and arthroplasty
- The operation of the century: total hip replacement · The Lancet · 2007 · 2,465 citations
- Psychometric Properties of Patient-Reported Outcome Measures for Hip Arthroscopic Surgery · The American Journal of Sports Medicine · 2013 · 444 citations
- Epidemiology of periprosthetic femur fracture around a total hip arthroplasty · Injury · 2007 · 367 citations
- Role of the Acetabular Labrum and the Iliofemoral Ligament in Hip Stability · The American Journal of Sports Medicine · 2011 · 323 citations
- Ceramics for Prosthetic Hip and Knee Joint Replacement · Journal of the American Ceramic Society · 2007 · 296 citations
- The new proximal femoral nail antirotation (PFNA®) in daily practice: Results of a multicentre clinical study · Injury · 2008 · 262 citations
- Activities of daily living in non-Western cultures: range of motion requirements for hip and knee joint implants · International Journal of Rehabilitation Research · 2001 · 253 citations
- Individual Risk factors for Hip Osteoarthritis: Obesity, Hip Injury and Physical Activity · American Journal of Epidemiology · 1998 · 251 citations
- Biocompatibility assessment of biomaterials used in orthopedic devices: An overview (Review) · Experimental and Therapeutic Medicine · 2021 · 245 citations
- Magnetic Resonance Imaging Versus Computed Tomography for Three‐Dimensional Bone Imaging of Musculoskeletal Pathologies: A Review · Journal of Magnetic Resonance Imaging · 2022 · 216 citations
Most recent work
- Role of polyetheretherketone (PEEK) in arthroplasty and orthopaedics: a review of biomechanical properties, surface modifications, and clinical outcomes · European Journal of Orthopaedic Surgery & Traumatology · 2026
- Unraveling corrosion and tribocorrosion mechanisms of stainless steel in chloride/bromide media: The dual role of corrosion products · Corrosion Science · 2026
- Smoking increases the risk of early postoperative infection after elective total hip arthroplasty: Evidence from a Nationwide Japanese database · International Orthopaedics · 2026
- Reimagining Orthopaedic Implants: Mechanobiochemical Innovations to Overcome Stress Shielding · Progress in Materials Science · 2026
- Can we trust the accuracy of the automatic calibration of the EOS system to measure lower limb length inequality after total hip arthroplasty? Comparison of EOS versus manual measurement on 110 calibrated radiographs · Orthopaedics & Traumatology: Surgery & Research · 2026
- Use of Short Femoral Stems in Primary Total Hip Arthroplasty: A Mid-Term Safety Analysis: Prospective series of 5,876 cases at 4.4-year average follow-up · Orthopaedics & Traumatology: Surgery & Research · 2026
- Microstructure, mechanical properties and fretting corrosion behavior of micro-arc oxide coatings on biomedical Ti6Al4V alloy for modular hip implant: Effect of Na2SiO3/KOH electrolyte concentration · Materials Chemistry and Physics · 2026
- Why revision of total hip arthroplasty fails: a retrospective consecutive cohort study of 963 patients · Bone & Joint Open · 2026
- Beyond jump distance: modular dual mobility versus single mobility cups in robotic total hip arthroplasty - simulation of hip kinematics and impingement · International Orthopaedics · 2026
- If the dead could speak, what would they teach? The hip arthroplasty register paradox. The Hernigou-Scarlat curves. Implants often outlive their owners! · International Orthopaedics · 2026
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