Intraoperative Assessment of Component Loosening in Hip Arthroplasty: An International Delphi Consensus
Abstract
BACKGROUND: This Delphi consensus study aimed to achieve international expert agreement on standardized intraoperative methods for assessing component loosening in total hip arthroplasty. The consensus involved revision hip surgeons from diverse health care settings worldwide and aimed to establish a consensus-based reference framework for future studies evaluating the diagnostic accuracy of preoperative assessment methods. METHODS: A three-round Delphi study was performed in accordance with Conducting and REporting of DElphi Studies guidelines. A panel of 125 orthopaedic surgeons from 32 countries was approached based on geographic representation and experience in revision total hip arthroplasty. In Round 1, open-ended questions were used to gather expert opinions, while in rounds 2 and 3, derived statements were rated using a Likert scale. Consensus was a priori defined as ≥ 70% agreement. There were 43 experts who completed Round 1, and 37 completed all three Delphi rounds. RESULTS: Consensus was reached on 15 of 48 statements (12 in round 2 and three in round 3), with the strongest agreement for visible motion of the component under compression, distraction, internal rotation, or external rotation of the leg, as the sign of actual looseness of the arthroplasty component. For manipulation techniques with the aim to load the arthroplasty components, consensus was reached on a limited number of items. CONCLUSIONS: This international Delphi consensus study provides the first expert-derived framework for intraoperative assessment of aseptic hip arthroplasty loosening. Visible component motion under compression, distraction, internal rotation, or external rotation of the leg emerged as the key indicator. Consensus was achieved for a limited number of manipulation techniques. These findings contribute to more standardized intraoperative assessment and provide a consensus-based reference framework in the absence of objective intraoperative measurement techniques, thereby improving comparability in future diagnostic accuracy studies. LEVEL OF EVIDENCE: Level V.
Related
- The Stryker Perform and Univers Apex short stems have different patterns of stress shielding but comparably low rates of loosening after reverse total shoulder arthroplasty
- CT-Based Assessment of Femoral Stem Anteversion After Intentional Intraoperative Rotational Adjustment of a Single-Wedge Tapered Stem in Total Hip Arthroplasty
- Asymmetric cement distribution in the coronal plane increases the risk of prosthetic loosening following total knee arthroplasty: an in-silico study.
- Accuracy of intraoperative limb length control using the NaviFast 6D system in total hip arthroplasty
- Agreement and Systematic Differences Between Intraoperative ROSA Hip-Knee-Ankle Measurements and Standing Radiographic Alignment After Robotic-Assisted Total Knee Arthroplasty: A Retrospective Agreement Study
BibTeX
@article{hopman2026intraoperative,
title = {{Intraoperative Assessment of Component Loosening in Hip Arthroplasty: An International Delphi Consensus}},
author = {Alon G.M. Hopman and Leendert Blankevoort and Derek Amanatullah and Sébastien Lustig and Matthias Schafroth and Arthur Kievit and Matthew Abdel and Bartolomé Allende and Jean-Noel Argenson and Francesco Benazzo and Bertrand Boyer and James Browne and Cao Li and Fabio Catani and Simon Coffey and José Cordero-Ampuero and Charles Aa Engh and Jean-Alain Epinette and Eduardo Garcia-Rey and A.M. Halder and Robert F.W. Hube and Theofilos Karachalios and Plamen Kinov and George Macheras and Bassam Masri and Geert Meermans and Lipalo Mokete and Carsten Perka and Filippo Randelli and W.H.C. Rijnen and Ola Rolfson and Hannes Rüdiger and Rachid Saouti and Mr.N. Amir Sandiford and Pablo Sanz-Ruiz and Ran Schwarzkopf and Peter Sculco and Andrew Shimmin and Krisztian Sisak and Rami Sorial and Scott Sporer and O.P.P. Temmerman and Kenneth Lu},
journal = {The Journal of Arthroplasty},
year = {2026},
month = sep,
doi = {10.1016/j.arth.2026.09.003},
url = {https://hal.science/hal-05746282v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Intraoperative Assessment of Component Loosening in Hip Arthroplasty: An International Delphi Consensus
AU - Alon G.M. Hopman
AU - Leendert Blankevoort
AU - Derek Amanatullah
AU - Sébastien Lustig
AU - Matthias Schafroth
AU - Arthur Kievit
AU - Matthew Abdel
AU - Bartolomé Allende
AU - Jean-Noel Argenson
AU - Francesco Benazzo
AU - Bertrand Boyer
AU - James Browne
AU - Cao Li
AU - Fabio Catani
AU - Simon Coffey
AU - José Cordero-Ampuero
AU - Charles Aa Engh
AU - Jean-Alain Epinette
AU - Eduardo Garcia-Rey
AU - A.M. Halder
AU - Robert F.W. Hube
AU - Theofilos Karachalios
AU - Plamen Kinov
AU - George Macheras
AU - Bassam Masri
AU - Geert Meermans
AU - Lipalo Mokete
AU - Carsten Perka
AU - Filippo Randelli
AU - W.H.C. Rijnen
AU - Ola Rolfson
AU - Hannes Rüdiger
AU - Rachid Saouti
AU - Mr.N. Amir Sandiford
AU - Pablo Sanz-Ruiz
AU - Ran Schwarzkopf
AU - Peter Sculco
AU - Andrew Shimmin
AU - Krisztian Sisak
AU - Rami Sorial
AU - Scott Sporer
AU - O.P.P. Temmerman
AU - Kenneth Lu
PY - 2026
DA - 2026/09/11
JO - The Journal of Arthroplasty
DO - 10.1016/j.arth.2026.09.003
UR - https://hal.science/hal-05746282v1
AB - BACKGROUND: This Delphi consensus study aimed to achieve international expert agreement on standardized intraoperative methods for assessing component loosening in total hip arthroplasty. The consensus involved revision hip surgeons from diverse health care settings worldwide and aimed to establish a consensus-based reference framework for future studies evaluating the diagnostic accuracy of preoperative assessment methods. METHODS: A three-round Delphi study was performed in accordance with Conducting and REporting of DElphi Studies guidelines. A panel of 125 orthopaedic surgeons from 32 countries was approached based on geographic representation and experience in revision total hip arthroplasty. In Round 1, open-ended questions were used to gather expert opinions, while in rounds 2 and 3, derived statements were rated using a Likert scale. Consensus was a priori defined as ≥ 70% agreement. There were 43 experts who completed Round 1, and 37 completed all three Delphi rounds. RESULTS: Consensus was reached on 15 of 48 statements (12 in round 2 and three in round 3), with the strongest agreement for visible motion of the component under compression, distraction, internal rotation, or external rotation of the leg, as the sign of actual looseness of the arthroplasty component. For manipulation techniques with the aim to load the arthroplasty components, consensus was reached on a limited number of items. CONCLUSIONS: This international Delphi consensus study provides the first expert-derived framework for intraoperative assessment of aseptic hip arthroplasty loosening. Visible component motion under compression, distraction, internal rotation, or external rotation of the leg emerged as the key indicator. Consensus was achieved for a limited number of manipulation techniques. These findings contribute to more standardized intraoperative assessment and provide a consensus-based reference framework in the absence of objective intraoperative measurement techniques, thereby improving comparability in future diagnostic accuracy studies. LEVEL OF EVIDENCE: Level V.
SN - 0883-5403
SN - 1532-8406
ER -