Background/Objectives: Total hip arthroplasty (THA) planning is crucial for restoring hip function and minimizing complications. The present systematic review and meta-analysis aimed to assess and compare the accuracy of 2D versus 3D preoperative planning in THA. Methods: The inclusion criteria were randomized controlled trials (RCTs) and observational studies (ROSs) published in English comparing the accuracy of 2D and 3D preoperative planning for total hip arthroplasty. We excluded review articles, registers, studies not written in English, studies that did not report the cup sizing accuracy or stem sizing accuracy or give a description of the preoperative planning method used, and non-comparative studies. In June 2024, following the PRISMA 2020 statement, a systematic review and a meta-analysis of the literature were conducted in PubMed, Scopus, and the Cochrane Library. The statistical analysis software Review Manager (RevMan) version 5.4 was used to perform the meta-analysis to compare the accuracy of 2D and 3D planning, and to assess the risk of bias, the ROBINS-I tool was used. Results: The analysis included 777 patients from six studies. The analysis showed that 3D planning offers superior precision compared to 2D planning, both for the cup (96.92% vs. 87.14%) and the stem (94.72% vs. 86.28%). The forest plots assessed a better trend for 3D planning in terms of exact size prediction and accuracy within ±1 size. Conclusions: The three-dimensional method was more precise and accurate than two-dimensional planning, both for the stem and the cup. It offered a detailed three-dimensional view of the patient’s anatomy. The main limitation was the challenge in finding homogeneous data regarding biomechanical parameters, surgical approaches, and different planning systems for both three-dimensional and two-dimensional methods.

Background: Iliopsoas impingement (IPI) is an increasingly recognized cause of persistent groin pain following total hip arthroplasty (THA), often resulting from mechanical conflict between the iliopsoas tendon and the anterior rim of the acetabular component. Despite its clinical relevance, risk factors contributing to IPI remain poorly defined. Methods: A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted according to PRISMA guidelines. Studies were eligible if they evaluated adult patients undergoing primary THA and reported at least one risk factor associated with IPI. Only studies with a clearly defined clinical diagnosis of IPI were included. Data extraction and risk of bias assessments were performed independently by two reviewers. Risk of bias in each study was assessed through the Newcastle-Ottawa Scale. Results: Twelve observational studies met the inclusion criteria. Diagnosis of IPI was based on clinical symptoms of anterior groin pain exacerbated by hip flexion; 9 studies confirmed diagnosis with anesthetic injections. Key surgical risk factors included anterior cup prominence (ORs 1.16–35.20), oversized cups (cup-to-head ratio > 1.2, OR = 5.39, or ≥6 mm difference, OR = 26.00), decreased cup inclination, collared stem protrusion (OR = 13.89), and acetabular screw protrusion > 6.4 mm. Patient-specific risk factors included female sex (ORs 2.56, 2.79), higher BMI (OR = 1.07), younger age, previous hip arthroscopy (OR = 9.60) and spinal fusion (OR = 4.60). The anterolateral approach was also associated with higher IPI risk when compared to the posterior approach (OR = 4.20). Conclusions: IPI after THA is a multifactorial complication influenced by modifiable surgical variables and patient-specific anatomy. Careful preoperative planning, precise implant positioning, and attention to individual risk factors are essential to reduce IPI incidence and improve outcomes.

Radiomics promises quantitative biomarkers extracted from routine hip imaging to support diagnosis, prognosis, and surgical planning, but current evidence is fragmented across pathologies, modalities, and computational pipelines. We conducted a scoping review following PRISMA-ScR and the Population–Concept–Context framework, including peer-reviewed original studies on adults (≥18 years) that applied radiomics or deep-radiomics to hip imaging (X-ray, CT, MRI, DEXA) with clinically relevant outcomes. PubMed (MEDLINE), Embase and Scopus (Elsevier) were searched from 1 January 2021 to 30 August 2025 and complemented by snowballing; screening and data charting were performed in duplicate. Given heterogeneity, findings were synthesized narratively by a priori clusters. In fragility/osteoporosis, opportunistic CT and radiograph-based models frequently achieved AUCs around 0.90–0.96, while DXA-radiomics added information beyond bone mineral density/FRAX and trabecular MRI provided complementary microarchitectural signals. For osteonecrosis of the femoral head, multisequence MRI enabled early diagnosis with AUCs > 0.94; radiomics differentiated transient bone marrow edema with AUCs~0.92–0.94 and predicted collapse using radiographs or MRI with AUCs~0.85–0.90, including automated pipelines with external validation around 0.85. In femoroacetabular impingement, 3D Dixon-MRI studies reported very high performance (~0.97–1.00) with preliminary multicenter generalizability and added value from periarticular soft-tissue features. In total hip arthroplasty, radiomics anticipated press-fit cup stability from preoperative radiographs (AUC~0.82) and predicted 6-month functional recovery using clinico-radiomic CT models (AUC~0.95). Across clusters, methodological robustness was variable (sample sizes, harmonization, leakage control, external/temporal validation, calibration, clinical utility). Radiomics for adult hip disorders shows tangible translational promise in opportunistic screening, complex differential diagnosis, and perioperative decision support, but broader clinical adoption will require multicenter datasets, IBSI-aligned standardization, transparent reporting of calibration and decision-curve analyses, and prospective validation.

Background: Accurate restoration of coronal-plane biomechanics after total hip arthroplasty (THA) needs assessment of the 2 aspects: global offset (GO) and leg-length discrepancy (LLD). The SGL index (sum of the leg-length discrepancy and the difference in global femoral offset) combines ΔGO and LLD into a single measure, which could provide a more complete evaluation than single-parameter measures. The study evaluates SGL for coronal restoration following THA, followed by GO restoration (±5 mm) and its femoral versus acetabular contribution. Methods: This retrospective analysis included 256 hips that underwent unilateral THA with standardised AP pelvic radiographs. Preoperative and postoperative measurements included femoral (FO), acetabular (AO), and GO, as well as LLD and SGL. The contralateral healthy hip was used as a reference, and accuracy was defined to be within ±5 mm. Results: SGL restoration (⩽5 mm) was achieved in 64.5% of hips; compared with non-restored cases, SGL-restored hips had higher postoperative FO (40.0 ± 5.5 vs. 38.5 ± 6.0 mm; t -test p = 0.050; Mann-Whitney p = 0.062), while AO did not differ. Preoperative offsets were similar. The contralateral (healthy) GO was higher in the non-restored group (71.1±7.7 vs. 68.9 ± 6.8 mm; t -test p = 0.024; Mann-Whitney p = 0.011). Conclusions: SGL is a valid parameter for determining coronal-plane restoration following THA. Among single measures, femoral offset (FO) is the most sensitive indicator of global offset restoration.

Basicervical femoral fractures (AO/OTA 31B3) are considered extracapsular injuries located at the base of the femoral neck, with features intermediate between intracapsular and pertrochanteric fractures. Their anatomical "borderline" position and mechanical instability have led to uncertainty regarding optimal management. This systematic review aimed to evaluate outcomes of cephalomedullary nails (CMN), sliding hip screws (SHS) and hip arthroplasty (HA) for strictly defined basicervical fractures and to identify which treatment strategies are associated with fewer implant failures. A systematic literature search (Medline/PubMed, Scopus, Cochrane) was performed according to PRISMA guidelines. English-language randomised controlled trials and prospective or retrospective observational studies were included if they specifically reported basicervical femoral fractures defined as AO/OTA 31B3 or as extracapsular fractures lateral to the femoral neck and medial to the greater trochanter without involvement of the lesser trochanter, treated with CMN, SHS or HA. Cadaveric, biomechanical and purely technical reports were excluded. Risk of bias was assessed using RoB 2 for RCTs and the Newcastle-Ottawa Scale for observational studies. Due to heterogeneity, data were synthesised descriptively. Sixteen studies with 1144 patients were analysed: 416 treated with CMN, 668 with SHS and 60 with HA. Overall implant failure occurred in 27 CMN cases (6.5%), 54 SHS cases (8.1%) and 2 HA cases (3.3%). Cut-out and non-union were the main failure modes after internal fixation, whereas avascular necrosis and new femoral neck fracture were rare. Across contemporary series, CMN and SHS showed broadly comparable failure patterns when adequate reduction and implant positioning were achieved. HA demonstrated low mechanical failure rates but was used in small, highly selected cohorts. Most studies were at least at moderate risk of bias. When basicervical fractures are strictly defined, both CMN and SHS appear to be acceptable options provided that anatomic or near-anatomic reduction and proper implant placement are obtained, while primary HA may be considered in frail elderly patients at high risk of fixation failure. Recognising basicervical fractures as a distinct entity and standardising their radiographic definition are essential to refine treatment algorithms, and high-quality prospective comparative studies are still needed. I.

Background: Femoral neck fractures in the elderly often necessitate hemiarthroplasty, but the optimal surgical approach remains a highly debated topic. The postero-lateral and direct lateral approaches are commonly employed, each with benefits and drawbacks. Despite their widespread use, robust, long-term comparative studies on definitive outcomes, including pain, functional recovery, and complication rates, are notably lacking. This systematic review and meta-analysis aim to address this critical gap by meticulously comparing these approaches with long-term follow-up. Methods: A systematic literature search was performed, including only comparative studies with a minimum 1-year follow-up. A meta-analysis was performed for the primary outcome measures: operative time, dislocations, infections, perioperative fractures and reoperations. Secondary outcomes included a qualitative synthesis of patient-reported outcomes (quality of life, pain, and satisfaction). Methodological quality was assessed using RoB 2.0 for randomized controlled trials and MINORS criteria for cohort studies. Results: Our meta-analysis provides robust quantitative evidence. The direct lateral approach is associated with a significantly lower risk of post-operative dislocations (I² = 58%; OR = 2.86, 95% CI: 2.53 to 3.22; p < 0.00001) and a significantly lower rate of reoperation (I² = 0%; OR = 1.25, 95% CI: 1.12 to 1.40; p = 0.0001) compared to postero-lateral approach. Operative time, infection, and perioperative fracture rates were found to be statistically comparable. However, patient-reported outcomes yielded inconsistent results across studies, often becoming non-significant after adjusting for confounders. Conclusions: This meta-analysis shows that the direct lateral approach is associated with lower rates of dislocation and reoperation compared with the postero-lateral approach, while patient-reported outcomes remain variable across studies. Further high-quality comparative trials are needed to confirm these associations and guide surgical decision-making.