Orthogate Subspecialty Journal Scan: Hip Arthroplasty & Joint Reconstruction

Curated critical appraisals of recent high-impact trials and clinical evidence across hip arthroplasty, evaluating dual-glucocorticoid fascial plane and peripheral nerve blocks versus periarticular infiltration in primary THA, intraosseous tranexamic acid for blood conservation, and wound complications after direct anterior THA, including bikini versus longitudinal incisions.

Featured Hip Studies This Edition (October 2026)
Hip Reconstruction

1. Glucocorticoid-Enhanced Fascial Plane and Peripheral Nerve Blocks Versus Periarticular and Local Infiltration Analgesia in Total Hip Arthroplasty: A Prospective Randomized Controlled Trial

Authors: Li J, Rubin L, Krishnan R, Blessing M, Townsend D et al. | Journal: The Journal of Bone and Joint Surgery (Am) (Oct 2026) | View Source / DOI

Situation

This randomized controlled trial compared an anterior quadratus lumborum block (aQLB) plus a lateral femoral cutaneous nerve block (LFCNB) with periarticular and local infiltration analgesia (PALIA) in primary total hip arthroplasty (THA), with both arms receiving the same dual-glucocorticoid regimen.

Background

Both strategies combine local anesthetic with hydrophilic dexamethasone sodium phosphate (DEX) and lipophilic methylprednisolone acetate (MPA). The trial asks whether a regional block pathway adds measurable benefit over surgeon-delivered periarticular infiltration when the adjuvant regimen is held constant.

Assessment & Findings
  • Study Design & Cohort: 192 patients were randomized to PALIA or aQLB+LFCNB; both received 60 mL of 0.2% ropivacaine, 10 mg of DEX, and 80 mg of MPA. The 188 included patients had a mean age of 61 years and 46% were male (93 aQLB+LFCNB, 95 PALIA in the final analysis). The authors rate the study Therapeutic Level II.
  • Primary Outcome (POD 1 Opioids): No significant difference in oral morphine milligram equivalents (oMME) on postoperative day (POD) 1 between aQLB+LFCNB (median 29.84; IQR 17.72 to 38.75) and PALIA (median 30.50; IQR 18.00 to 42.00; P = 0.57).
  • Secondary Outcomes: POD 2 opioid consumption, white blood-cell count, Brief Pain Inventory (BPI) severity and interference, and functional recovery (AMPAC and PROMIS) from POD 0 to 1 year showed no significant differences.
  • Fasting Glucose: The only significant secondary difference was a lower POD 1 fasting serum glucose with aQLB+LFCNB (median 141.50 mg/dL) than with PALIA (median 153.00 mg/dL; P = 0.003). The abstract does not report on the clinical significance of this difference.
Recommendation & Practice Takeaway

Clinical Pearl: With a dual-glucocorticoid regimen in both arms, aQLB plus LFCNB produced no difference in opioid consumption, pain scores, or functional recovery compared with periarticular and local infiltration. Where surgeon-delivered PALIA is already well established, this trial does not support adding a separate block pathway for analgesic benefit alone (editorial interpretation; costs and workflow were not studied).

Hip Reconstruction

2. Efficacy of Intraosseous Tranexamic Acid in Primary Total Hip Arthroplasty: A Prospective Randomized Controlled Trial

Authors: Chen Y, Cao L, Ji B, Li G, Zhang X | Journal: The Journal of Arthroplasty (Oct 2026) | View Source / DOI

Situation

This randomized controlled trial evaluated whether intraosseous (IO) tranexamic acid (TXA) is noninferior to intravenous (IV) or topical TXA in primary total hip arthroplasty.

Background

TXA reduces blood loss and transfusion requirements in primary total hip arthroplasty, but the optimal route of administration remains unclear.

Assessment & Findings
  • Study Design & Cohort: Equal-proportion noninferiority randomized trial of 126 patients (October 2024 to April 2025) allocated to IO TXA (20 mg/kg into the cancellous bone of the femur and ilium), IV TXA (20 mg/kg five minutes before incision), or topical TXA (20 mg/kg before suture). The abstract does not state a level of evidence; the Level I badge reflects the randomized design.
  • Primary Outcome (Hemoglobin Reduction): Mean hemoglobin reduction was comparable across groups on the day of surgery and POD 1, 2, and 3 (P = 0.431, 0.532, 0.479, and 0.443, respectively).
  • Exploratory Blood Loss: Mean calculated total blood loss was lower in the IO group on the day of surgery and POD 1 (P = 0.005 and 0.016, respectively); the authors note the clinical relevance of this finding remains uncertain.
  • Transfusion & Adverse Events: Transfusion rates were 2.3% (IO), 7.1% (IV), and 2.3% (topical) (P = 0.434). One patient in the topical group developed deep vein thrombosis; no pulmonary embolism or infections were reported.
Recommendation & Practice Takeaway

Clinical Pearl: Intraosseous TXA was noninferior to IV and topical TXA for blood conservation in primary THA, with a possible early blood-loss advantage that the authors describe as of uncertain clinical relevance. IO delivery is a reasonable alternative route, but the authors call for further high-quality studies before claiming superiority.

Hip Reconstruction

3. Systematic Review of Wound Complications After Direct Anterior Approach Total Hip Arthroplasty: Incidence, Risk Factors, and Management Strategies

Authors: Subramanian T, Oles A, Halayqeh S, Mazzucco M, Jolissaint J et al. | Journal: The Journal of the American Academy of Orthopaedic Surgeons (Oct 2026) | View Source / DOI

Situation

Wound complications after direct anterior approach (DAA) total hip arthroplasty (THA) are an important source of postoperative morbidity. This systematic review characterized their incidence, risk factors, and management, with a meta-analysis comparing transverse (bikini) and longitudinal incisions.

Background

Several risk factors and management strategies for DAA wound complications have been proposed, but the existing data remain heterogeneous.

Assessment & Findings
  • Study Design & Cohort: Systematic review across eight databases following PRISMA guidelines, including 36 studies encompassing 35,300 DAA THAs. The incision comparison used a common-effects meta-analysis. The abstract does not state a level of evidence; the badge reflects the review design.
  • Incidence of Wound Events: The most common complications were superficial dehiscence/drainage (1.41%), superficial surgical site infection (1.34%), delayed wound healing (1.15%), and hematoma/seroma (0.80%).
  • Incision Type: Transverse (bikini) incisions were associated with a significantly lower risk of wound complications than longitudinal incisions (relative risk 0.45; 95% CI, 0.23 to 0.89; P = 0.0219).
  • Risk Factors & Management: Obesity and female sex were the most frequently identified risk factors. Closure technique and dressing choice showed variable influence. Most wound complications were successfully managed with local wound care, avoiding the need for revision surgery.
Recommendation & Practice Takeaway

Clinical Pearl: DAA wound complications are relatively uncommon and usually respond to conservative care. A transverse (bikini) incision was associated with roughly half the risk of wound complications compared with a longitudinal incision, so incision choice deserves deliberate consideration, particularly in patients with obesity and in female patients. Because the comparison is drawn from heterogeneous, largely nonrandomized data, it supports rather than mandates the bikini approach.

Orthogate Weekly Journal Scan is curated and synthesized by ORION (Orthopaedic Research, Intelligence & Operations Navigator) for orthopaedic surgeons, fellows, and residents. Evidence synthesized under the clinical direction of Christian Veillette, MD, MSc, FRCSC.