Cemented Hip Replacement: An In-Depth Review
Research Overview
Cemented hip replacement has become a significant surgical intervention for managing hip joint diseases. It is essential to explore the existing literature to understand this approach thoroughly. The prevailing key findings in recent research show that proper implementation of cemented implants can lead to favorable outcomes in terms of patient recovery and long-term joint function. Furthermore, studies indicate that selecting appropriate materials is crucial for the success and longevity of the implants.
Summary of Key Findings
- Patient Outcomes: Numerous studies reveal that patients who undergo cemented hip replacements often experience reduced pain levels and improved mobility. The follow-up duration varies, but many report satisfaction over several years post-surgery.
- Material Considerations: The choice of cement is vital. Polymethylmethacrylate (PMMA) is the most common cement used, known for its reliability. Research highlights the importance of the cement’s viscosity and polymerization exotherm in ensuring secure fixation.
- Complications: While many patients benefit from this procedure, complications can occur. Problems like infection, implant loosening, and periprosthetic fractures are observed, though they tend to be infrequent with proper surgical protocols.
"Cemented hip replacements are associated with high satisfaction rates, but understanding the possible complications is equally crucial for comprehensive care."
Importance of the Research
Understanding cemented hip replacement is crucial not just for surgeons but also for healthcare teams and patients. This surgical option significantly impacts quality of life for individuals suffering from arthritis or trauma. By reviewing contemporary research, we can better appreciate the clinical protocols that lead to successful outcomes, guiding future practices and improving patient care.
Methodology
For a comprehensive analysis, various research methodologies have been employed in the literature surrounding cemented hip replacements. This overview focuses on study designs and data collection techniques seen in relevant studies.
Study Design
Many of the evaluated studies utilize randomized controlled trials (RCTs), cohort studies, or systematic reviews. RCTs provide a high level of evidence by minimizing bias, while cohort studies offer insights over longer timescales, tracking changes in patient outcomes over years.
Data Collection Techniques
Data collection techniques vary based on the study design. Common approaches include:
- Patient Surveys: Collecting subjective data through questionnaires to assess pain levels and satisfaction post-surgery.
- Clinical Assessments: Regular follow-up examinations to monitor joint functionality and detect complications early.
- Imaging Techniques: Radiographic evaluations aid in understanding the positioning and stability of the implant.
In summary, the research surrounding cemented hip replacement not only informs surgical practice but also contributes to better rehabilitation strategies. Recognizing both the benefits and potential complications enhances the overall understanding of this important topic.
Overview of Cemented Hip Replacement
Cemented hip replacement is a widely performed orthopedic procedure. Understanding it is essential for those involved in the field of joint surgery. This method involves using bone cement to fix a prosthesis into the patient's bone. The fixation method is crucial for the long-term stability of the implant, and it influences both the surgery's success and the patient's outcome.
Definition of Cemented Hip Replacement
Cemented hip replacement refers to a surgical procedure where a prosthetic hip joint is secured in place using polymethyl methacrylate (PMMA) bone cement. This type of implant provides immediate stability, making it suitable for various patient demographics. The cement fills the space between the bone and the prosthesis, ensuring a tight fit that prevents movement. This secure bond allows for early mobilization, which can lead to reduced postoperative complications.
Historical Context and Development
The evolution of cemented hip replacement has deep roots in surgical innovation. Initially, hip replacement surgeries focused on using uncemented implants. In the 1960s, advancements in materials and surgical techniques led to the widespread adoption of cemented implants. Surgeons recognized that PMMA could enhance the longevity and performance of hip replacements. Since then, research has continued to improve the materials, techniques, and outcomes associated with cemented replacements. Studies have shown that these implants can offer excellent functional results with low failure rates over extended periods. The historical significance is evident in today's surgical practices which still rely on these foundational concepts in orthopedic surgery.
"The introduction of cement in hip arthroplasty marked a pivotal moment in orthopedic surgery, transforming outcomes for countless patients."
By understanding the overview of cemented hip replacement, readers can grasp the importance of this procedure. The ongoing development and refinement of techniques and materials demonstrate its significance in modern orthopedic medicine.
Indications for Cemented Hip Replacement
Cemented hip replacement is an established procedure with a range of clinical applications. Understanding the indications is paramount for effective surgical practice. The selection of patients for this procedure involves a multitude of factors that ensure optimal outcomes and enhance the quality of life for those suffering from hip joint ailments.
Degenerative Joint Disease
Degenerative joint disease, notably osteoarthritis, represents one of the primary indications for cemented hip replacement. This condition leads to the gradual wear and tear of cartilage in the hip joint, causing pain, stiffness, and reduced mobility. For patients with advanced stages of osteoarthritis, conservative treatments often become insufficient.
Cemented hip replacement can significantly alleviate symptoms and restore function. The procedure provides stable fixation, allowing for immediate weight-bearing activities post-surgery. Patients often experience enhanced joint function and reduced pain levels, improving their overall quality of life.
Traumatic Injuries
Traumatic injuries to the hip can result from accidents or falls. Common injuries include fractures of the femoral neck or acetabulum. Such injuries require prompt intervention, particularly in elderly individuals or those with complex fractures.
Cemented hip replacement serves as a robust solution for these patients, particularly when other methods of fixation may not guarantee adequate healing. The fixation provided by bone cement ensures that the implant remains well positioned, allowing for a quicker return to daily activities. The urgency of addressing traumatic injuries makes this application of cemented implants particularly relevant.
Patient Age and Activity Level
The age and activity level of patients are crucial considerations in deciding on cemented hip replacement. Generally, this surgical option is favored for older adults whose bone quality may limit the effectiveness of uncemented implants. Older patients often have a higher likelihood of achieving successful outcomes with cemented fixation, as it compensates for potentially poor bone ingrowth.
Moreover, a patient’s activity level affects the decision process. Highly active individuals may benefit from uncemented implants to encourage biological fixation over time. Conversely, less active patients often find immediate stability with cemented implants preferable.
In summary, determining the suitability of cemented hip replacement involves a careful analysis of degenerative conditions, trauma, age, and activity levels. This multi-faceted approach helps maximize patient outcomes and satisfaction, thus reinforcing the importance of understanding these indications in clinical practice.
Surgical Techniques
Surgical techniques form a critical foundation in cemented hip replacement. Their importance lies in ensuring the safety and efficiency of the operation. The method an orthopedic surgeon chooses directly influences not only the surgical outcomes but also the speed of recovery and overall patient satisfaction. Specialized techniques aim to minimize trauma, enhance implant fixation, and reduce the risk of complications. Understanding these techniques helps professionals make informed decisions that can greatly benefit their patients.
Preoperative Planning
Preoperative planning is essential for the success of a cemented hip replacement. It involves assessing the patient's medical history, imaging, and physical examination results. Detailed evaluations allow for the identification of specific needs, such as the correct size and type of implant. This stage is vital for minimizing errors during surgery. Physicians often use advanced imaging techniques like CT or MRI to visualize the hip joint in detail, which aids in precise implant placement. Moreover, engaging the patient in discussions about their expectations and potential outcomes leads to better overall satisfaction.
Anesthesia Options
The choice of anesthesia impacts both intraoperative conditions and postoperative recovery. Common options for anesthesia during a cemented hip replacement include general anesthesia and regional anesthesia, such as spinal or epidural anesthesia.
- General Anesthesia: This option is straightforward, allowing the patient to be completely unconscious during the procedure. It is useful in cases with high anxiety or other associated medical conditions that complicate the surgery.
- Regional Anesthesia: This is often preferred by many surgeons as it allows for quicker recovery and less pain management post-surgery. Regional anesthesia can also reduce the risk of certain complications, such as deep vein thrombosis.
Approaches to Surgery
The surgical approaches in cemented hip replacement greatly influence the outcome of the procedure. Each approach has distinctive characteristics, advantages, and disadvantages.
Anterior Approach
The anterior approach involves accessing the hip joint from the front of the body. A key characteristic of this approach is its ability to preserve muscle and soft tissue, which can lead to quicker recovery times and less postoperative pain.
- Benefits: A lower risk of dislocation and reduced surgical trauma are significant advantages.
- Drawbacks: It requires specialized training and may not be suitable for all patients based on their anatomy.
Posterior Approach
The posterior approach is one of the most commonly used techniques. It provides excellent visibility of the surgical field and allows for thorough assessment of the hip joint structures.
- Benefits: This method can be advantageous in cases where extensive exposure is necessary.
- Drawbacks: There is a slightly higher risk of dislocation post-surgery compared to the anterior approach.
Lateral Approach
The lateral approach offers a compromise between the anterior and posterior techniques. It grants good visibility of the joint and, like the anterior route, can minimize muscle damage.
- Benefits: This can provide stable fixation and reduce dislocation risk.
- Drawbacks: Recovery might be slightly slower compared to the anterior approach, and some surgeons may find it technically challenging.
Implant Selection and Preparation
Choosing the right implant and preparing it appropriately are steps that can significantly affect the surgical outcome. Surgeons must consider patient-specific factors such as age, activity level, and bone quality. The selection of cement and cleaning of the implant surface both play a crucial role in ensuring adequate bonding between the implant and bone cement. Proper preparation also includes assessing the patient’s individual anatomy, which ensures the best fit for the implant. This personalized approach can lead to improved longevity of the implant and better functional outcomes for the patient.
Materials Used in Cemented Implants
Cemented hip replacements rely heavily on the materials used in their implants. This topic is critical because the selection of materials affects the longevity and performance of the implant. When assessing cemented hip replacements, one must consider the overall mechanical properties, biocompatibility, and durability of these materials.
Bone cement, for instance, serves as a bonding agent between the implant and the bone, providing stability and support. The composition of this cement can significantly impact the outcomes for patients. Durable materials, like high-quality alloys and polyethylene components, are essential for ensuring that the implants withstand the forces they encounter.
In this section, we shall delve into the specifics of bone cement composition and the various implant materials, including metallic alloys, polyethylene components, and ceramics. Each material has its own key characteristics, unique features, and potential pros and cons, which are crucial in determining their appropriateness for specific cases.
Bone Cement Composition
Bone cement acts as a crucial bonding substance in cemented hip replacements. It typically consists of polymethyl methacrylate (PMMA). Its primary role is to fill any gaps between the implant and the bone. One of the benefits is its strong adhesion to the bone, ensuring that the implant remains securely in place for extended periods. However, the curing process of PMMA releases heat, which can potentially damage surrounding bone tissue if not managed properly.
Implant Materials
Metallic Alloys
Metallic alloys, particularly titanium and cobalt-chromium alloys, are commonly used in cemented hip replacements. Their key characteristic is high strength and resistance to corrosion. This makes them a popular choice, as they offer a long-lasting implant option.
One unique feature of metallic alloys is their ability to handle considerable stress. They can endure the mechanical strains associated with hip motion. Despite these advantages, the potential for metal fatigue over time remains a consideration.
Polyethylene Components
Polyethylene components are vital in providing smooth surfaces for joint movement. A key characteristic of polyethylene is its low friction in articulation, which reduces wear over time. Because of these benefits, it is a beneficial choice for cemented hip replacements. The unique feature of modern cross-linked polyethylene is enhanced wear resistance, which significantly extends the implant's life. However, it can be prone to fatigue failure, which is a drawback in certain cases.
Ceramics
Ceramics are increasingly used in cemented hip implants due to their excellent wear properties. They are characterized by high hardness and biocompatibility, making them a favorable option for many patients. Ceramics offer the unique feature of being very smooth, which promotes less friction in joint movement, thus enhancing longevity. Nevertheless, a disadvantage is their brittleness, which can increase the risk of fracture under abnormal loading conditions.
Advances in Material Science
Recent advancements in material science have led to the development of new composites and surface treatments that improve the durability and lifespan of implant materials. These innovations are addressing the longstanding issues related to wear and loosening of implants. Continued research in this area remains paramount in enhancing the effectiveness of cemented hip replacements.
Postoperative Care
Postoperative care is a crucial aspect of the cemented hip replacement process. This phase plays a significant role in ensuring optimal recovery and long-term success of the surgical procedure. Proper care minimizes complications and promotes effective healing, facilitating a quicker return to daily activities. The postoperative period can often signal the difference between a successful outcome and a challenging recovery.
Immediate Postoperative Protocols
Immediate postoperative protocols are essential for patient safety and recovery. These protocols often include monitoring vital signs, managing pain, and ensuring the stability of the hip replacement. Patients may remain in the recovery room for a few hours post-surgery, where healthcare providers closely observe their response to anesthesia and manage any discomfort.
Key elements include:
- Monitoring Vital Signs: Ensuring blood pressure, heart rate, and oxygen levels remain stable.
- Pain Management: Utilizing medications such as acetaminophen or opioids as needed to control discomfort.
- Preventing Complications: Initiating measures to prevent deep vein thrombosis and pulmonary embolism, often through mechanical compression devices or early mobilization, if appropriate.
These measures help create a foundation for a positive recovery experience.
Rehabilitation Approaches
Rehabilitation after hip replacement surgery is tailored to each patient’s individual needs, focusing on restoring mobility and strength. Rehabilitation usually begins as early as the first day after surgery, emphasizing the importance of gradual mobilization. Physical therapists often play a crucial role, guiding exercises that enhance joint function and prevent stiffness.
Common rehabilitation strategies include:
- Range of Motion Exercises: Initially focusing on gentle movements to reestablish mobility.
- Strength Training: Gradually introducing exercises that build muscular support around the hip.
- Gait Training: Encouraging patients to practice walking with assistive devices to ensure safety and confidence.
The rehabilitation phase is integral to achieving a successful outcome, helping patients transition back to their previous lifestyle.
Monitoring Complications
Monitoring for complications is an ongoing process in the postoperative phase that cannot be underestimated. It is essential to identify potential issues early on to avoid long-term problems. Common complications include infection, blood clots, and issues related to the cement used in the hip replacement.
Healthcare providers usually adhere to rigorous monitoring protocols, including:
- Regular Follow-ups: Scheduled appointments to assess healing progress and implant stability.
- Signs of Infection: Educating patients about symptoms like redness, swelling, or discharge around the surgical site.
- Cement-related Concerns: Observing for symptoms of loosening or other complications specific to the cemented hip replacement.
Regular monitoring empowers patients and providers to address issues promptly, ultimately safeguarding the surgical success.
Postoperative care is vital for ensuring the success of cemented hip replacements and minimizing complications.
Outcomes and Effectiveness
The outcomes and effectiveness of cemented hip replacement are crucial in evaluating its long-term viability as a surgical intervention. Understanding these outcomes involves analyzing various elements such as success rates, patient satisfaction levels, and functional improvements. These metrics help guide healthcare professionals in making informed decisions about the management of patients requiring hip replacement surgery. The significance of these outcomes cannot be overstated, as they ultimately affect patient quality of life and return to daily activities.
Success Rates
Success rates for cemented hip replacements generally indicate high levels of effectiveness. Various studies show that the majority of patients experience significant pain relief and regained function post-operatively. The success of the procedure is often measured through prosthesis survival rates, which play a major role in defining long-term effectiveness. According to recent clinical evidence, the survival rate of cemented implants can reach above 90% within the first ten years when monitored adequately.
Factors influencing these success rates include:
- Surgical technique: Proper surgical methods are paramount in enhancing the implant's stability.
- Implant design: The materials used and the engineering behind the implant significantly affect outcomes.
- Patient comorbidities: Pre-existing health conditions can impact recovery and implant performance.
Patient Satisfaction Levels
Patient satisfaction is a critical metric in assessing the overall effectiveness of cemented hip replacements. Surveys and follow-up studies generally report high levels of satisfaction among patients. These surveys often ask participants about pain reduction, mobility improvement, and overall quality of life.
Key determinants of patient satisfaction include:
- Pain management: Efficient management of post-surgical pain leads to higher satisfaction.
- Functional recovery: Patients who experience quicker recoveries tend to report better satisfaction levels.
- Expectations: Patients' preoperative expectations about outcomes can significantly influence their satisfaction.
Functional Improvements
Functional improvements are often the main focus following a cemented hip replacement. Many patients report enhanced mobility and a quicker return to normal activities. The goal of the surgery is to restore not just comfort but also functional ability. Various metrics are used to evaluate these improvements, such as range of motion, strength, and the ability to perform daily tasks.
Significant functional outcomes include:
- Increased range of motion: Patients typically regain substantial motion in the hip joint post-surgery.
- Strength restoration: Rehabilitation efforts following surgery contribute to regaining strength in the hip and surrounding muscles.
- Return to activities: Most patients can return to their previous activity levels, including low-impact sports and daily tasks, enhancing their overall quality of life.
In summary, assessing outcomes and effectiveness in cemented hip replacement provides valuable insights. Successful implementations signal positive trends in patient recovery and satisfaction, offering a qualitative and quantitative view of this surgical approach.
Complications Associated with Cemented Hip Replacement
Understanding complications associated with cemented hip replacement is pivotal for both healthcare professionals and patients. Recognizing potential risks can lead to more informed decisions regarding surgical options and postoperative care. It fosters a better comprehension of what to expect during recovery, thus potentially improving patient satisfaction and outcomes. This section delves into significant complications that can arise, specifically focusing on infection risks, periprosthetic fractures, and cement-related issues.
Infection Risks
Infection remains one of the most significant concerns following any surgical procedure, including cemented hip replacement. The risk of surgical site infections may arise from various factors such as skin flora, the duration of surgery, and the patient's overall health. Infections can lead to increased morbidity, prolonged hospital stays, and in severe cases, necessitate additional surgeries.
Preventative measures during the surgical process are critical. Using sterile techniques, proper antibiotic prophylaxis, and maintaining strict hygiene standards can mitigate these risks.
It is essential for patients to be aware of symptoms post-surgery, including redness, swelling, and discharge around the incision site. Prompt recognition and treatment of potential infections can significantly affect overall recovery. Additionally, continuous research into optimal strategies for infection prevention shows promise in enhancing surgical outcomes.
Periprosthetic Fracture Risks
Periprosthetic fractures refer to fractures that occur around the joint prosthesis, often leading to complications that can complicate recovery. These fractures can occur due to trauma, implant loosening, or as a result of underlying bone density concerns. Elderly patients, in particular, may be at increased risk due to osteoporotic changes.
Factors affecting fracture risk include:
- Quality of bone: Poor bone quality increases susceptibility to fractures.
- Implant design: The choice and placement of the implant can impact stability.
- Patient activity level: More active patients might be at higher risk if they engage in high-impact activities post-recovery.
Timely diagnosis of a periprosthetic fracture is crucial. This often includes imaging studies, followed by treatment that may involve surgical fixation or revision surgery to restore stability and function.
Cement-related Issues
Cemented hip replacements rely heavily on bone cement for the stability of the implant. However, various issues can arise related to the cement itself. One prominent concern is whether the cement provides sufficient fixation to prevent loosening over time. Loosening can lead to pain and require revision surgery.
Additionally, the quality of the cement application is vital. Poor mixing or application techniques can lead to gaps between the cement and the bone, which can compromise the bond. Aseptic loosening, where the cement fails to bond properly without an infection present, is another critical challenge.
Ongoing advancements are being made in cement formulations to enhance their properties, including better adherence and reduced risk of wear over time. Understanding these issues is vital for both patients and practitioners, as they play a significant role in long-term outcomes and the durability of the implant.
Comparative Analysis with Uncemented Implants
Comparing cemented and uncemented hip implants is crucial for understanding the best practices in hip replacement surgery. Each method offers distinct advantages and disadvantages, which can significantly impact surgical outcomes and patient recovery. The choice between these techniques often depends on various factors, including the patient's age, activity level, and bone quality.
Differences in Technique
The fundamental difference in surgical technique between cemented and uncemented hip replacements lies in how the implant is secured to the bone. Cemented implants utilize polymethylmethacrylate, commonly known as bone cement. This method involves the direct application of cement into the bone and onto the implant during surgery. This can provide immediate stability. On the other hand, uncemented implants rely on biological fixation, designed to promote bone growth into the surface of the implant over time. This often involves a rough or porous surface that encourages osseointegration.
The choice of technique has important implications. Cemented implants generally allow for a quicker burden on the joint post-surgery. However, the cement may degrade over time, potentially leading to complications such as loosening of the implant. Uncemented methods require a longer healing time as the bone needs to grow into the prosthetic.
Patient Selection Criteria
Selecting the appropriate surgical technique involves assessing the unique characteristics of each patient. Age plays a critical role; younger patients often have greater bone quality and physical activity levels, favoring uncemented implants. Conversely, older patients, especially those with weaker bones, may benefit more from the stability provided by cemented implants.
Other considerations include:
- Bone Density: Patients with low bone density may have better outcomes with cemented implants due to their immediate stability.
- Activity Level: Highly active individuals may be more suited for uncemented implants to ensure long-term stability and function.
- Surgeon Experience: Surgeons’ skill and experience with either technique can influence outcomes significantly.
Long-term Outcomes
Long-term outcomes are a significant aspect of the comparative analysis between cemented and uncemented hip replacements. Studies show that cemented implants tend to have lower rates of early revision due to their fixation method. However, as time goes on, the risk of loosening in the cement can rise, often leading to the need for eventual revision surgery.
Uncemented implants, while initially requiring a longer adjustment period, often exhibit favorable long-term results, especially in younger, active patients. They can provide durability and longevity if osseointegration is achieved successfully.
"Patient lifestyle and expectations should guide the choice between cemented and uncemented implants to ensure optimal outcomes."
Future Trends in Cemented Hip Replacement
The landscape of cemented hip replacement surgery is evolving. As technology advances, new methods and materials are being integrated into traditional practices. These developments are essential for not just improving surgical outcomes but also enhancing patient experience and recovery. Understanding these trends helps healthcare professionals anticipate changes and improve clinical practice.
Emerging Technologies
In recent years, the emergence of new technologies has started to impact cemented hip replacement. Innovations in imaging techniques, such as 3D imaging and intraoperative navigation systems, allow surgeons to view anatomy in greater detail. This enhances precision during the procedure, minimizing complications.
Robotic-assisted surgery is another technological advancement. This technique ensures more consistent outcomes by allowing for better alignment and positioning of implants. Studies have shown improved accuracy and potentially faster recovery times with robot-assisted approaches compared to traditional methods.
Innovative Surgical Techniques
Surgical techniques are also advancing. The development of minimally invasive approaches is a significant trend. These methods aim to reduce tissue trauma by using smaller incisions. This not only results in less pain for patients but also decreases the length of hospital stays.
Also, the concept of enhanced recovery after surgery (ERAS) is gaining traction. This protocol involves optimizing every aspect of patient care, from the preoperative period to discharge, focusing on minimizing opioid use and promoting early mobilization. It aims to improve overall recovery and patient satisfaction.
Research Directions
Research in the field is expanding. Ongoing studies focus on long-term outcomes of cemented vs. uncemented implants, specifically looking at better understanding the longevity and performance of different materials. The goal is to identify the best practices that can guide future clinical decisions.
The use of biocompatible materials is another area of exploration. Researchers are evaluating newer cement formulations and implant surfaces to minimize complications like infection. The implications of these studies could lead to significant improvements in patient outcomes.
The End
The conclusion of this article provides a critical wrap-up of the field of cemented hip replacement surgery. It highlights the various aspects discussed throughout the paper, offering a cohesive summary that cements the understanding of this surgical approach. The significance of concluding remarks extends beyond mere summarization; it helps reinforce the practical applications of cemented implants and the relevant data that supports their use.
Summary of Key Points
This article has illuminated several key areas regarding cemented hip replacement:
- Definition and Context: The fundamental aspects have been articulated, setting a base for readers unfamiliar with this procedure.
- Indications for Surgery: Clinicians should consider degenerative joint disease and patient age when deciding on this intervention.
- Surgical Techniques: Knowledge of various approaches enhances surgical precision and effectiveness.
- Materials: The evolution of bone cement and implant materials was discussed, indicating advances that improve outcomes.
- Postoperative Care: Strategies for rehabilitation and monitoring post-surgery complications play a pivotal role in patient recovery.
- Comparative Analysis: Evaluating cemented versus uncemented implants showcases the ongoing debate in orthopedics.
- Future Trends: The potential of emerging technologies and innovative techniques in the realm of hip replacement suggests a promising horizon.
Implications for Clinical Practice
The findings and considerations in this article bear significant implications for healthcare professionals involved in orthopedic surgery. Understanding the effectiveness and associated risks of cemented hip replacement can lead to better patient selection. Surgeons must weigh the benefits of cemented implants against potential complications, tailoring their approach to individual patient needs.
Moreover, the insights related to rehabilitation facilitate informed discussions with patients regarding their recovery journey. Continuous research and evolving techniques in cemented hip replacement can enhance surgical outcomes and elevate patient satisfaction. As such, staying updated with the latest developments is essential for practitioners aiming to optimize their clinical strategies.
"A thorough understanding of cemented hip replacements enables surgeons to make informed choices, ultimately improving patient care and outcomes."
The article's exploration of these dimensions not only enriches the knowledge base of practitioners but also serves as a foundation for ongoing research and development in hip arthroplasty.
