BJJ - 2026-06-01 - Journal Article; Consensus Statement
Diagnosis of aseptic loosening after hip arthroplasty : international Delphi consensus.
Hopman AGM, Blankevoort L, Lustig S, Amanatullah DF, Schafroth MU, Kievit AJ, Hip Arthroplasty Loosening (HAL) Study Group, Abdel MP, Allende BL, Argenson JA, Benazzo F, Boyer B, Browne JA, Cao L, Catani F, Coffey S, Cordero-Ampuero J, Engh CA, Epinette JA, Garcia-Rey E, Halder AM, Hube RFW, Karachalios T, Kinov P, Masri BA, Macheras G, Meermans G, Mokete L, Perka C, Randelli F, Rijnen WHC, Rolfson O, Rüdiger HA, Saouti R, Sandiford NA, Sanz-Ruiz P, Schwarzkopf R, Sculco PK, Shimmin A, Sisak K, Sorial R, Sporer SM, Temmerman OPP, Urish KL
Topics
Key Takeaway
A 37-expert international Delphi panel reached consensus on 25 clinical and radiological criteria for diagnosing aseptic loosening in THA, with PJI exclusion unanimously designated as the mandatory first diagnostic step.
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Summary
This three-round Delphi study sought international expert consensus on clinical and radiological criteria for diagnosing aseptic loosening in THA, using a ≥70% agreement threshold. Of 125 approached surgeons from 32 countries, 37 completed all rounds, yielding consensus on 25 statements. PJI exclusion was unanimous as the first step; thigh pain and pain with rotation indicated femoral loosening; groin pain and start-up pain indicated acetabular loosening; plain radiographs were primary imaging with CT reserved for uncertain cases.
Key Limitation
Consensus threshold of 70% is relatively low and the final panel of 37 represents only 30% of those initially approached, meaning the statements may not reflect true expert majority opinion across the broader revision arthroplasty community.
Original Abstract
AIMS
This Delphi consensus study aimed to achieve international expert agreement on clinical and radiological criteria for diagnosing aseptic component loosening in total hip arthroplasty (THA). The consensus involved revision hip surgeons from diverse healthcare settings worldwide, aiming to standardize diagnostic criteria and enhance clinical decision-making and future research comparability.
METHODS
A three-round Delphi study was conducted in accordance with Conducting and Reporting of Delphi Studies guidelines. A panel of 125 orthopaedic surgeons from 32 countries was approached based on geographical representation and experience in revision THA. In Round 1, experts listed clinical and imaging criteria; in Rounds 2 and 3, derived statements were rated on a Likert scale. Consensus was a priori defined as ≥ 70% agreement. A total of 43 experts completed Round 1, and 37 completed all three Delphi rounds.
RESULTS
Consensus was achieved on 25 clinical and radiological statements. Investigations for periprosthetic joint infection was unanimously considered the first step. Limping and pain were general indicators of loosening. Pain during weightbearing, hip rotation, start-up, or localized to the thigh was linked to femoral loosening. Pain at start-up, in the groin, or during activities was associated with acetabular loosening. Radiographs were the primary imaging modality, supported by serial radiographs and CT in uncertain cases. Key radiological indicators included progressive radiolucency, osteolysis, implant migration, broken screws, and cortical thickening.
CONCLUSION
The consensus statements from this study establish key clinical and radiological parameters for diagnosing aseptic loosening in THA, recommending plain radiographs as the primary imaging modality and CT as secondary. The results lay the groundwork for more standardized diagnostic protocols and improved consistency in future clinical practice and research.