JOA - 2026-09-09 - Journal Article
Intraoperative Assessment of Component Loosening in Hip Arthroplasty: An International Delphi Consensus.
Hopman AGM, Blankevoort L, Amanatullah DF, Lustig S, Schafroth MU, Kievit AJ, Members Hip Arthroplasty Loosening (HAL)-Study Group
Topics
Key Takeaway
International Delphi consensus (n=37 revision THA experts, 32 countries) reached agreement on only 15 of 48 statements, with visible component motion under compression, distraction, internal or external rotation as the sole strongly agreed-upon indicator of intraoperative loosening.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This three-round Delphi study following CREDES guidelines sought expert consensus on standardized intraoperative methods for diagnosing component loosening in revision THA. Thirty-seven revision hip surgeons from 32 countries rated 48 statements; consensus (≥70% agreement) was reached on only 15 statements (31%), with the strongest agreement for visible component motion under mechanical loading as the definitive loosening sign. Consensus on specific manipulation techniques to load components was achieved for only a limited subset of items, highlighting the absence of standardized intraoperative assessment protocols.
Key Limitation
Consensus was reached on only 31% of statements (15/48), meaning the majority of intraoperative assessment practices remain without expert agreement, limiting the framework's immediate clinical prescriptiveness.
Original Abstract
BACKGROUND
This Delphi consensus study aimed to achieve international expert agreement on standardized intraoperative methods for assessing component loosening in total hip arthroplasty (THA). The consensus involved revision hip surgeons from diverse healthcare 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 (CREDES) guidelines. A panel of 125 orthopaedic surgeons from 32 countries was approached based on geographic representation and experience in revision THA. 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.
CONCLUSION
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.