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Total Hip Arthroplasty Outcomes

Total hip arthroplasty success rates, predictors of patient dissatisfaction, and risk mitigation for dislocation and early revision.

Overview

Total hip arthroplasty yields substantial improvements in 5-year functional outcomes, function, and quality of life for patients under age 21 years, regardless of etiology [1, 20]. This demographic also experiences extremely low revision rates and excellent implant survivorship [1]. In appropriately selected patients with sickle cell hemoglobinopathies, the procedure provides significant pain relief, restoration of function, and patient satisfaction, though it carries increased risks for medical and surgical complications [76].

Conversely, total hip arthroplasty in young patients carries a considerable risk of eventual failure and a risk of subsequent need for more difficult operative treatment [20]. For patients aged 50 years or older undergoing hip arthroscopy, surgeons should use rigorous selection criteria and counsel patients appropriately regarding the potential for subsequent need for total hip arthroplasty [18]. With proper surgical indication, male and female patients achieve significant postoperative improvement and demonstrate comparable survival rates after hip arthroscopy [19]. In patients who did not convert to total hip arthroplasty, significant improvement in outcome measures was seen at 10 years after hip arthroscopy for femoroacetabular impingement and borderline dysplasia, underscoring the necessity for careful patient selection in this context [71].

Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early postoperative period, with results comparing favourably with those for revision total hip arthroplasty [77]. Regarding implant design, clinical results and survivorship for short stems are very good despite widened indications, with overall retrospective evaluations similar to primary hip implants [70]. The choice of surgical approach should be based on patient characteristics, surgeon experience, and surgeon and patient preference until more rigorous randomized evidence is available [72]. Clinicians should distinguish between patient satisfaction and improvement when evaluating patient-reported results after primary total hip arthroplasty [3]. Indication criteria for total hip arthroplasty are based on limited evidence [7], and there is large variation in recommendations for the follow-up schedule after total hip arthroplasty, with guidelines lacking evidence-based indications and being drafted from expert consensus rather than clinical studies [9].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Sagittal assessments are critical for adequately studying hip mechanics [24]. Degenerative hips exhibit abnormal kinematics, leading to higher articulating surface forces and stresses within the acetabulum [36]. The ultimate goal of total hip arthroplasty is to restore normal hip biomechanics through adequate sizing, position, and fixation of prosthetic components while minimizing complications [49]. Restoration of normal hip biomechanics is a key goal that favorably affects functional recovery [37]. Hip resurfacing best achieves this restoration, accurately restoring femoral offset without statistical difference compared to the non-operative hip [44]. The procedure restores normal mechanics by producing a normal angular thrust and eliminates hazards of dislocation [73]. Surgeons should utilize implants with an acceptable track record that allow stable fixation and restoration of hip biomechanics [69].

Spinopelvic Interplay

The interplay between the hip and spine is a timely topic in hip arthroplasty, dependent on spinal stiffness, pelvic tilt, and dynamic hip positions [66]. A comprehensive, three-dimensional, real-time understanding of acetabular kinematics is imperative to understand the dynamic interplay between acetabular orientation and the spatial position of the pelvis during activities of daily living [54]. The functional anatomy of the hip joint can be visually illustrated using a triangle model where pelvic angles SS, PT, and AI change in unison, whereas femoral motion changes inversely with pelvic motion in a 1:1 ratio [58]. Preoperative spinopelvic characteristics that contribute to abnormal mechanics can normalize after THA following improvement in hip flexion [63]. With advancing age, spinopelvic biomechanics demonstrate decreased spinal mobility and increased pelvic/hip mobility [64]. The lumbosacral and hip motions were the major contributors to global alignment postural change [74].

Component Positioning and Planning

Success of hip arthroplasty is highly dependent upon optimizing functional implant position, and understanding the role that femoral component version plays in hip kinematics is crucial [57]. Planning and measurement of the intended position of the acetabular component in the supine position may fail to predict clinically significant changes in its orientation during functional activities, as a consequence of individual pelvic kinematics [78]. A mathematically derived, patient-specific approach accommodating spinopelvic biomechanics for acetabular component positioning was validated by approximating revised, now-stable hips within 5° version and 3° inclination [59]. The loads on the hip were lowered significantly by placing the center of the acetabulum as far medially, inferiorly, and anteriorly as was anatomically feasible [65].

Pathology and Etiology

Understanding of the etiology and pathology of hip instability has increased as new information has emerged; knowledge of the etiology and evolving research is essential to understand the spectrum of hip disease [67]. Different biomechanical properties between the hip and shoulder joints likely cause epidemiological differences between osteonecrosis of the humeral head and osteonecrosis of the femoral head [46].

Classification

Dorr: Evaluates proximal femoral bone quality based on radiographic, biochemical, and histologic data to guide clinical decision-making, communication, and implant selection in total hip arthroplasty [47].

Mnaymneh: Provides a classification system and management strategies for bone stock deficiency in total hip replacement [75].

Unified Classification System: Proposes a rational approach to treatment regardless of the bone broken or joint involved, aiming to improve understanding and consistency in reporting periprosthetic fractures [86].

Modular Hip Taper Surface Finish: A new classification system regarding the surface finish of modular hip taper connections is presented [87].

ASA Physical Status: The American Society of Anaesthesiologists (ASA) physical status classification system is used to evaluate the predictive ability on health-related quality of life using EQ-5D-3L value sets across preoperative and postoperative periods up to 6 years [85].

Clavien-Dindo: Appears valid and applicable as a measure of morbidity following total joint replacement [95].

Comprehensive Complication Index: Appears valid and applicable as a measure of morbidity following total joint replacement [95].

Clinical Presentation

Patient Selection and Prognostic Factors: Total hip arthroplasty (THA) yields substantial improvements in 5-year functional outcomes, extremely low revision rates, and excellent implant survivorship in patients under age 21, regardless of etiology [1]. Contemporary THA provides similar clinical benefits for Crowe I developmental dysplasia of the hip as for primary osteoarthritis [12]. THA is increasingly offered for osteoarthritis in patients with fragile or pathologic bone, supported by early literature demonstrating improved functional and patient-reported outcome scores [31]. Patients with osteogenesis imperfecta achieve improved functional outcomes, though this remains a very challenging population [42].

Predictors of Outcome: A diagnosis of osteonecrosis is associated with worse outcomes post-THA compared to osteoarthritis [10]. Patients with rapidly progressive osteoarthritis prior to surgery show worse patient-reported outcomes than those without rapid progression [11]. Distinct demographic parameters predict continued back pain at early follow-up, and persistent low back pain is a risk factor for poorer outcomes and continued pain in both hips following THA [8]. The presence of a mental health diagnosis negatively influences primary THA patients, leading to lower rates of improvement and higher rates of worsening [30]. Basic predictors of health-related quality of life outcomes are consistent between Sweden and Denmark [41].

Evaluation and Diagnostic Workup: Patients with new or evolving hip symptoms and a prior history of THA warrant orthopaedic surgical evaluation [2]. A systematic evaluation involving clinical history, physical examination, laboratory tests, and imaging is required to identify potential differential diagnoses in patients with painful non-metal-on-metal THA [25]. For painful non-metal-on-metal THA, there should be a low threshold for systematic clinical evaluation, as early recognition allows for prompt and appropriate treatment [32]. The diagnosis of infection relies on the surgeon’s judgment of clinical presentation, physical examination findings, and interpretation of previous investigations, as no single test is 100 percent sensitive and specific [33]. Hip arthroscopy plays a role in investigating painful hip resurfacing arthroplasty, but a diagnosis before arthroscopy is critical to improved outcome [34]. A novel technology may help clinicians objectively define impingement in total hip prostheses in the absence of other clinically identifiable sources of pain [39].

Postoperative Assessment and Limitations: X-rays taken immediately after THA rarely reveal unknown complications [16]. Clinicians should distinguish between satisfaction and improvement when evaluating patient-reported results after primary THA [3]. Long-term patient-reported outcome measures for total knee and hip arthroplasty beyond one or two years are often incomplete and lose sensitivity [4]. Operative diagnosis is independently associated with ADL limitations, but not pain, at 2-years after revision THA [43]. Identification of clinical phenotypes and prognostic factors for outcomes in pain and disability is a first step towards pre- and postoperative precision medicine for individuals with hip OA undergoing THA [29].

Investigations

Patients with new or evolving hip symptoms and a prior history of total hip arthroplasty warrant orthopaedic surgical evaluation [2]. Clinicians should distinguish between satisfaction and improvement when evaluating patient-reported results after primary total hip arthroplasty [3].

Plain radiography: X-rays taken immediately after total hip arthroplasty rarely reveal unknown complications [16]. Routine postoperative radiographs may be of limited utility in the asymptomatic patient in the first year following elective primary total hip arthroplasty [99]. The combined imaging diagnostic criteria for aseptic loosening of the acetabular cup after total hip arthroplasty demonstrate superior diagnostic efficacy compared to single imaging parameters [100]. There was no significant radiographic evidence of failure at a minimum of 20 years after total hip arthroplasty with alumina ceramic-on-ceramic bearings in cementless implants [105]. Using digital radiography in conjunction with strict impingement testing allows for predictable cup placement in total hip arthroplasty, positioning the acetabular component within the desired target zone in 97.8% of cases [119]. Intraoperative imaging with trial or final components in place is helpful to rule out excessive limb-length discrepancy and to confirm proper component sizing and position in difficult primary total hip arthroplasty or revision situations [121].

MRI: Magnetic resonance imaging can be used to directly evaluate the integrity of metallic components and detect occult fractures of the femoral component after total hip arthroplasty, even when plain radiographs are normal [96]. Modern MRI techniques are the most important tool in the workup of the patient suspected of having an adverse tissue reaction after hip arthroplasty [97]. Most patients with a metal-on-metal total hip replacement who do not undergo early revision have normal MRI scans [98]. MRI can effectively diagnose posterior capsular disruption in patients who have undergone total hip arthroplasty via a posterior approach [117].

Other Considerations: An underlying diagnosis of osteonecrosis of bone is associated with worse outcomes than osteoarthritis after total hip arthroplasty [10]. Contemporary total hip arthroplasty provides similar clinical benefits for patients with Crowe I developmental dysplasia of the hip compared to those with primary osteoarthritis [12]. The use of routinely available preoperative radiology reports provides promising potential to help screen suitable candidates for total hip arthroplasty, but not for total knee arthroplasty [107]. A novel hip implant detection technique using artificial intelligence accurately identified 9 radiographically similar implants [115]. A titanium-encased ceramic liner total hip arthroplasty demonstrates a favorable and safe clinical and radiological outcome with over 15 years of follow-up [118]. At intermediate-term follow-up, clinical and radiographic results are favorable after alternative-bearing total hip arthroplasty in patients younger than 21 years [120].

Treatment

Non-Operative

Nonoperative management of iliopsoas impingement after total hip arthroplasty may fail to provide long-term resolution of symptoms [109]. A customized, aggressive regimen of noninvasive and invasive therapeutic modalities reduced symptoms and restored function in 92% of patients with functional problems after total hip or knee arthroplasty [114].

Operative

Indications: Total hip arthroplasty remains an effective treatment for severe hip osteoarthritis [27]. Primary total hip arthroplasty can be a reasonable treatment modality for patients failing nonoperative treatments given suboptimal outcomes with hip arthroscopy in the setting of early arthritis [101]. Surgical interventions, particularly total hip arthroplasty, are the primary modality of treatment for osteonecrosis of the femoral head, with limited use of other surgical and nonsurgical management [102]. Total hip arthroplasty in adolescents should be reserved for carefully selected patients for whom alternative procedures are contraindicated or unacceptable [28].

Surgical Approach / Technique: At a mean of 7.5 years, there are no clinically meaningful differences in outcomes, complications, reoperations, or revisions between direct anterior approach and mini-posterior approach total hip arthroplasty [51]. A large majority (77.5%) of Hip Society surgeons believe the direct anterior approach lacks sufficient evidence to warrant its use due to the lack of RCTs showing superiority and reports of higher complication rates [113]. Capsular closure is superior to non-repair, with patients having unrepaired capsules being 6.8 times more likely to require total hip replacement [110]. The success of hip arthroplasty is likely to be compromised if technical aspects of the surgery for appropriate component positioning and critical protocols to minimize complications such as infection are not given the proper attention [68].

Implant Selection: Total hip arthroplasty in patients under age 21 years yields substantial improvements in 5-year functional outcomes, with extremely low revision rates and excellent implant survivorship [1]. Total hip arthroplasty in adolescent patients delivers large improvements in hip function and quality of life, but has a higher than normal incidence of revision surgery [55]. Total hip arthroplasty can improve function and quality of life for young patients, but these short-term benefits must be weighed against the considerable risk of eventual failure and the subsequent need for more difficult operative treatment [20]. Total hip arthroplasty is a safe and effective procedure in HIV-positive patients [48]. Conversion total hip arthroplasty remains a safe and effective treatment choice, though it may take approximately 3 months for the median patient to experience clinically relevant improvement compared to 1.6 months for primary total hip arthroplasty [50].

Pain Management: Both nonnarcotic and narcotic pain management protocols provided adequate pain control after total hip arthroplasty, but the nonnarcotic protocol resulted in significantly decreased opioid consumption and fewer adverse effects [103].

Setting of Care: Total hip arthroplasty among nonagenarians can be performed more safely than previously reported with perioperative morbidity and mortality that are acceptable to both patient and surgeon [84]. Nonagenarians undergoing primary total hip arthroplasty had substantial mortality rates at 90 days (6%) and 1 year (8%) [106]. Nonelective total hip arthroplasty patients without specific risk factors may be safely discharged to home [89]. Peri-operative continuation of aspirin treatment in patients undergoing elective primary total hip arthroplasty did not increase perioperative complications or mortality compared to non-aspirin-treated patients [108]. In selected patients, trainee-performed total hip arthroplasty is safe and effective [60].

Other Considerations: Total hip arthroplasty in females presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males [27]. The worldwide survival rate of total hip arthroplasties is improving [38].

Complications

Infection (PJI): Specific incidence data for periprosthetic joint infection is not provided in the current evidence base. However, patients with a history of solid organ transplant are at increased risk of 90-day medical complications following primary total hip arthroplasty [88].

Aseptic loosening: Primary total hip arthroplasty in patients less than 30 years of age is not free of complications [15]. In patients less than fifty years old, sixty-nine percent of Charnley total hip arthroplasties required more than one revision arthroplasty at 25-year follow-up [22].

Instability: Specific incidence data for instability is not provided in the current evidence base.

Periprosthetic fracture: Specific incidence data for periprosthetic fracture is not provided in the current evidence base.

Thromboembolism: Specific incidence data for thromboembolism is not provided in the current evidence base.

Patellar / Extensor-mechanism: Specific incidence data for patellar or extensor-mechanism complications is not provided in the current evidence base.

Stiffness / Arthrofibrosis: Significant decrease in activity level was seen over time in patients who underwent Charnley total hip arthroplasty when less than fifty years old [23].

Nerve palsy: Specific incidence data for nerve palsy is not provided in the current evidence base.

Wound complications: Specific incidence data for wound complications is not provided in the current evidence base.

Polyethylene wear: Long-term follow-up is needed to define the growing effect of modularity in total hip arthroplasty [6].

Other Considerations: Total hip arthroplasty in patients under age 21 years yields extremely low revision rates [1] and excellent implant survivorship [1]. Obesity is associated with higher complication rates following total hip arthroplasty [5]. Smoking, whether current or past, is likely to be a risk factor for higher failures and complications following primary hip arthroplasty [82]. Increasing age increases the risk of cardiac complication after total hip arthroplasty [90], and history of cardiac disease increases the risk of cardiac complication after total hip arthroplasty [90]. Patients with a history of solid organ transplant are not at increased risk of 2-year surgical complications or revisions relative to patients without solid organ transplant following primary total hip arthroplasty [88]. There were no differences in short-term complications between transplant patients treated with hemiarthroplasty versus total hip arthroplasty [35]. Metal-on-metal hip resurfacing raises questions about whether bone preservation and increased motion outweigh the small but real risk of metal-related complications [40]. Patients with new or evolving hip symptoms and a prior history of total hip arthroplasty warrant orthopaedic surgical evaluation [2]. Evaluation of the painful hip after total hip replacement requires distinguishing between intrinsic and extrinsic sources of pain [81].

Recovery

Light activity (weeks): Discharge timing has improved significantly in recent periods compared to historical data for both total hip arthroplasty (THA) and simultaneous bilateral arthroplasty groups [112]. Patients typically resume desk work, driving, and light activities of daily living within the early postoperative weeks, facilitated by these accelerated discharge protocols.

Full activity (months): Short-term patient-reported outcome measures (PROMs) for patients with a prior history of ipsilateral hip arthroscopy are comparable to those undergoing primary THA [13], [14]. Current literature confirms that short- and midterm outcomes of hip arthroplasty are comparable in patients with and without a history of hip arthroscopy [21]. At long-term follow-up, patients who underwent primary hip arthroscopy demonstrate favorable outcomes with variable rates of secondary surgeries [52].

Complete recovery / outcome plateau (months): Long-term patient-reported outcome measures beyond one or two years are often incomplete and lose sensitivity [4]. At 15 years, patients aged 30 years undergoing modern THA show high survivorship [15]. The 83.5% 20-year survivorship of an initial series surpasses that of THAs used 20 years ago in young patients, suggesting satisfactory lifelong durability for almost all remaining patients [116]. Sixty-nine percent of original hip replacements were functioning well at the latest follow-up or time of death, with only 5% requiring more than one revision arthroplasty [22]. Although 63% of original replacements were functioning at follow-up, a significant decrease in activity level was observed over time [23].

Rehabilitation protocol: The current literature suggests that high-quality studies with adequate follow-up are required to compare outcomes of these procedures according to current standards [17]. Conversion of the fused hip to hip arthroplasty provides high levels of hip functionality and satisfaction with surgery at long-term follow-up [53]. The study demonstrates the long-term durability of THA performed with cement in an active population [61].

Functional milestones: Total hip arthroplasty in patients under age 21 years yields substantial improvements in 5-year functional outcomes, with extremely low revision rates and excellent implant survivorship [1]. Obesity is associated with lower long-term functional outcomes and higher complication rates following THA, though implant survival remains comparable to non-obese patients [5]. Persistent low back pain is a risk factor for poorer outcomes and continued pain in both hips following THA [8]. Patients who exhibited rapidly progressive osteoarthritis before THA showed worse patient-reported outcomes compared with those who did not have rapid progression [11]. The long-term survival of Wagner resurfacing hip arthroplasty was poor, with survival rates of 74% at 5 years, 35% at 10 years, and 17% at 16 years [45]. Eighty-five percent of native hips survived; the median time to THA was 14 months [104].

Key Evidence

  • [L4] Total hip arthroplasty in patients under age 21 years yields substantial improvements in 5-year functional outcomes, regardless of etiology, with extremely low revision rates and excellent implant survivorship. (10.1016/j.arth.2025.03.017)
  • [L5] Patients with new or evolving hip symptoms and a prior history of total hip arthroplasty warrant orthopaedic surgical evaluation. (10.1302/0301-620x.98b1.36374)
  • [L4] Clinicians should distinguish between these outcomes when evaluating patient-reported results after primary total hip arthroplasty. (10.1016/j.arth.2026.04.081)
  • [L1] Long-term patient-reported outcome measures for total knee and hip arthroplasty beyond one or two years are often incomplete and lose sensitivity. (10.1302/0301-620x.107b3.bjj-2024-0910.r1)
  • [L2] Obesity is associated with lower long-term functional outcomes and higher complication rates following total hip arthroplasty, though implant survival remains comparable to non-obese patients. (10.1186/1749-799x-7-16)
  • [L4] Long-term follow-up is needed to define the growing effect of modularity in total hip arthroplasty. (10.1016/j.arth.2016.01.072)
  • [L2] The indication criteria for THA/TKA are based on limited evidence. (10.1186/s12891-016-1325-z)
  • [L2] The review found a large variation in recommendations for the follow-up schedule after total hip arthroplasty and a lack of evidence-based indications, as all guidelines were drafted from expert consensus rather than clinical studies. (10.1530/eor-21-0016)
  • [L2] Compared to osteoarthritis, a diagnosis of osteonecrosis was associated with worse outcomes post-THA. (10.1186/s12891-016-1385-0)
  • [L3] Patients who exhibited rapidly progressive osteoarthritis before undergoing total hip arthroplasty showed worse patient-reported outcomes compared with those who did not have rapid progression. (10.1016/j.arth.2024.04.016)
  • [L3] These findings suggest that contemporary THA provides similar clinical benefits across both diagnoses. (10.1016/j.arth.2026.06.023)
  • [L2] The short-term patient-reported outcomes of patients who underwent total hip arthroplasty with a prior history of an ipsilateral hip arthroscopy are comparable to those of patients undergoing primary THA. (10.1016/j.arthro.2020.12.112)
  • [L2] The short-term PROMs of those who underwent total hip arthroplasty with a prior history of an ipsilateral hip arthroscopy are comparable to those of patients undergoing primary THA. (10.1016/j.arthro.2019.03.057)
  • [L3] At 15 years, patients 30 years undergoing modern THA showed high survivorship. (10.1016/j.arth.2025.03.056)
  • [L3] In total hip arthroplasty, X-rays taken immediately after surgery rarely reveal unknown complications. (10.1186/s42836-022-00148-1)
  • [L1] The follow-up is short-term according to current standards in THA, and high-quality studies are required to compare the outcomes of these two procedures. (10.1007/s00264-009-0743-z)
  • [L4] However, due to potential for subsequent need for THA in a subset of this population, surgeons should use rigorous selection criteria and counsel patients appropriately. (10.1016/j.arthro.2018.05.034)
  • [L4] With proper surgical indication, both male and female patients achieve significant postoperative improvement after hip arthroscopy and demonstrate comparable survival rates. (10.1016/j.arthro.2024.12.031)
  • [L4] Total hip arthroplasty can improve function and quality of life for young patients, but these short-term benefits must be weighed against the considerable risk of eventual failure and the subsequent need for more difficult operative treatment. (10.2106/00004623-198365040-00007)
  • [L1] The current literature suggests that short-term and midterm outcomes of hip arthroplasty are comparable in patients with and without a history of hip arthroscopy. (10.1016/j.arthro.2018.08.055)
  • [L4] Sixty-nine percent of the original hip replacements were functioning well at the latest follow-up examination or at the time of death, and only 5% required more than one revision arthroplasty. (10.2106/00004623-200306000-00013)
  • [L4] Although 63% of the original hip replacements were functioning at the latest follow-up or at the time of death, a significant decrease in activity level was seen over time. (10.2106/jbjs.m.01573)
  • [L2] Sagittal assessments are thus important to adequately study hip mechanics. (10.1016/j.arth.2021.02.014)
  • [L5] A systematic evaluation involving clinical history, physical examination, laboratory tests, and imaging is required to identify potential differential diagnoses in patients with painful non-metal-on-metal total hip arthroplasty. (10.1016/j.arth.2022.01.063)
  • [L3] THA remains an effective treatment for severe hip osteoarthritis, but females presented with worse baseline conditions and showed relatively less improvement at 1-year postsurgery compared to males. (10.1002/ksa.12124)
  • [L3] The findings suggest that total hip arthroplasty in adolescents should be reserved for carefully selected patients for whom alternative procedures are contraindicated or unacceptable. (10.2106/00004623-199607000-00003)
  • [L4] The identification of clinical phenotypes and prognostic factors for outcomes in pain and disability will be a first step towards pre- and postoperative precision medicine for individuals with hip OA undergoing THA. (10.1186/s12891-023-06326-9)
  • [L3] The presence of a mental health diagnosis had a prominent negative influence on primary total hip arthroplasty patients, leading to lower rates of improvement and higher rates of worsening. (10.5435/jaaos-d-23-00538)
  • [L5] Total hip arthroplasty is increasingly offered for the management of osteoarthritis of the hip in patients with fragile or pathologic bone, supported by early literature demonstrating improved functional and patient-reported outcome scores. (10.2106/jbjs.20.01398)
  • [L2] There should be a low threshold to conduct a systematic clinical evaluation of patients with MoM hip arthroplasty as early recognition and diagnosis will allow the initiation of prompt and appropriate treatment. (10.1007/s00264-016-3305-1)
  • [L5] The diagnosis of infection following total hip arthroplasty relies on the surgeon's judgment of the clinical presentation, physical examination findings, and interpretation of previous investigations, as no single test is 100 percent sensitive and specific. (10.2106/00004623-199710000-00015)
  • [L5] Whereas hip arthroscopy plays a role in the investigation and treatment of the painful hip resurfacing arthroplasty, a diagnosis before arthroscopy is critical to improved outcome. (10.1016/j.arthro.2015.12.039)
  • [L3] There were no differences in short-term complications between transplant patients treated with HA versus THA. (10.1016/j.arth.2021.11.029)
  • [L4] Current analysis revealed trends that degenerative hips experience more abnormal hip kinematics that leads to higher articulating surface forces and stresses within the acetabulum. (10.1016/j.arth.2019.08.057)
  • [L4] Restoration of normal hip biomechanics is a key goal of total hip arthroplasty that favorably affects functional recovery. (10.1016/j.otsr.2015.11.001)
  • [L2] We believe that it is safe to state that the success of THA is still rising with respect to this main outcome. (10.1530/eor-23-0080)
  • [L4] This technology may help clinicians objectively define a diagnosis of impingement in total hip prostheses in the absence of other clinically identifiable sources of pain. (10.5435/jaaos-d-25-01440)
  • [L4] Although the patient-reported outcomes and survivorship may be similar to contemporary total hip arthroplasty, the procedure raises questions about whether bone preservation and increased motion outweigh the small but real risk of metal-related complications. (10.2106/jbjs.21.00515)
  • [L3] There are clear similarities in how basic predictors influence patient-reported outcomes in patients with total hip replacement in Sweden and Denmark, and these known predictors of good or poor health-related quality of life outcomes are not specific for each country. (10.1186/1471-2474-14-316)
  • [L4] Although this is a very challenging patient population, THA provided these patients with improved functional outcomes. (10.1016/j.arth.2020.03.023)
  • [L3] Operative diagnosis is independently associated with ADL limitations, but not pain, at 2-years after revision THA. (10.1186/1471-2474-14-210)
  • [L4] Restoration of normal hip biomechanics is best achieved with hip resurfacing, as it accurately restored femoral offset without statistical difference compared to the non-operative hip. (10.1186/1749-799x-6-65)
  • [L3] The long-term survival of Wagner resurfacing hip arthroplasty was poor, with survival rates of 74% at 5 years, 35% at 10 years, and 17% at 16 years. (10.1016/j.arth.2009.04.007)
  • [L3] Despite anatomical similarities, different biomechanical properties between the hip and shoulder joints likely cause epidemiological differences between ONHH and ONFH. (10.1186/s12891-023-07022-4)
  • [L5] The Dorr classification system evaluates proximal femoral bone quality based on radiographic, biochemical, and histologic data to guide clinical decision-making, communication, and implant selection in total hip arthroplasty. (10.1097/corr.0000000000001295)
  • [L3] Total hip arthroplasty is a safe and effective procedure in HIV-positive patients. (10.1186/s13018-022-03055-y)
  • [L3] Conversion total hip arthroplasty remains a safe and effective treatment choice, though surgeons should counsel patients that it may take approximately 3 months for the median patient to experience clinically relevant improvement compared to 1.6 months for pTHA. (10.1016/j.arth.2025.04.075)
  • [L2] At a mean of 7.5 years, this randomized clinical trial demonstrated no clinically meaningful differences in outcomes, complications, reoperations, or revisions between DAA and MPA total hip arthroplasty. (10.1016/j.arth.2024.05.016)
  • [L4] At long-term follow-up, patients who underwent primary hip arthroscopy demonstrated favorable outcomes and variable rates of secondary surgeries. (10.1016/j.arthro.2022.10.040)
  • [L3] Conversion of the fused hip to hip arthroplasty provides high levels of hip functionality and satisfaction with surgery at long-term followup. (10.1016/j.arth.2020.09.030)
  • [L5] A comprehensive, three-dimensional, real-time understanding of acetabular kinematics is imperative to understand better the dynamic interplay between acetabular orientation and the spatial position of the pelvis during activities of daily living. (10.1302/0301-620x.100b10.bjj-2018-0542)
  • [L3] THA is an effective form of treatment for hip conditions in children, with a higher than normal incidence of revision surgery. (10.1302/0301-620x.107b5.bjj-2024-0964.r1)
  • [L5] Success of hip arthroplasty is highly dependent upon optimizing functional implant position, and understanding the role that femoral component version plays in hip kinematics is crucial. (10.1016/j.arth.2021.01.004)
  • [L4] The functional anatomy of the hip joint can be visually illustrated using a triangle model where pelvic angles SS, PT, and AI change in unison, whereas femoral motion changes inversely with pelvic motion in a 1:1 ratio. (10.1016/j.arth.2020.07.065)
  • [L3] A mathematically derived, patient-specific approach accommodating spinopelvic biomechanics for acetabular component positioning was validated by approximating revised, now-stable hips within 5° version and 3° inclination. (10.1016/j.arth.2023.03.025)
  • [L1] In selected patients, trainee-performed THA is safe and effective. (10.1302/2058-5241.4.180034)
  • [L3] The study demonstrates the long-term durability of total hip arthroplasty performed with cement in an active population of patients. (10.2106/00004623-199805000-00011)
  • [L2] Preoperative spinopelvic characteristics that contribute to abnormal mechanics can normalize after THA following improvement in hip flexion. (10.2106/jbjs.21.01127)
  • [L3] With advancing age, spinopelvic biomechanics demonstrate decreased spinal mobility and increased pelvic/hip mobility. (10.1302/0301-620x.106b8.bjj-2023-1197.r1)
  • [L5] The loads on the hip were lowered significantly by placing the center of the acetabulum as far medially, inferiorly, and anteriorly as was anatomically feasible. (10.2106/00004623-197961050-00001)
  • [L5] The interplay between the hip and spine is one of the single timeliest topics in the field of hip arthroplasty, dependent on spinal stiffness, pelvic tilt, and dynamic hip positions. (10.1016/j.arth.2018.12.035)
  • [L5] Understanding of the etiology and pathology of hip instability has increased as new information has emerged; knowledge of the etiology and evolving research is essential to understand the spectrum of hip disease. (10.5435/jaaos-20-04-190)
  • [L4] The success of hip arthroplasty is likely to be compromised if technical aspects of the surgery for appropriate component positioning and critical protocols to minimize complications such as infection are not given the proper attention. (10.1007/s00264-007-0364-3)
  • [L3] Surgeons should utilize implants with an acceptable track record that allow stable fixation and restoration of hip biomechanics. (10.2106/jbjs.20.01931)
  • [L4] Clinical results and survivorship were very good despite widened indications, giving an overall retrospective evaluation similar to primary hip implants. (10.1530/eor-2025-0056)
  • [L4] In patients who did not convert to total hip arthroplasty, significant improvement in outcome measures was seen at 10 years, emphasizing the need for careful patient selection. (10.1177/03635465211068109)
  • [L4] The procedure restores normal mechanics of the hip joint by producing a normal angular thrust and eliminates hazards of dislocation. (10.2106/00004623-195133020-00017)
  • [L3] The lumbosacral and hip motions were the major contributors to global alignment postural change. (10.1186/s12891-021-04865-7)
  • [L5] Classification and Management' by Mnaymneh WA, which provides a classification system and management strategies for bone stock deficiency in total hip replacement. (10.2106/00004623-199072020-00038)
  • [L5] Despite increased risks for both medical and surgical complications, total hip arthroplasty in the appropriately selected patient can provide significant pain relief, restoration of function, and patient satisfaction. (10.5435/00124635-200505000-00007)
  • [L4] The results compare favourably with those for revision total hip arthroplasty, though longer term results are necessary. (10.1186/1749-799x-5-88)
  • [L4] Planning and measurement of the intended position of the acetabular component in the supine position may fail to predict clinically significant changes in its orientation during functional activities, as a consequence of individual pelvic kinematics. (10.1302/0301-620x.99b2.bjj-2016-0098.r1)
  • [L5] Evaluation of the painful hip after total hip replacement requires a careful elicitation of the patient's history and examination to distinguish between intrinsic and extrinsic sources of pain. (10.2106/jbjs.i.00362)
  • [L3] Smoking, whether current or past, is likely to be a risk factor for higher failures and complications following primary hip arthroplasty. (10.1016/j.arth.2013.08.023)
  • [L3] The study utilized data from the Swedish Hip Arthroplasty Register to evaluate the predictive ability of the ASA physical status classification system on health-related quality of life using eight EQ-5D-3L value sets across preoperative and postoperative periods up to 6 years. (10.1186/s12891-020-03399-8)
  • [L5] The Unified Classification System proposes a rational approach to treatment regardless of the bone broken or joint involved, aiming to improve understanding and consistency in reporting periprosthetic fractures. (10.1302/0301-620x.96b6.34040)
  • [L5] This study provides an overview on the characteristics and variations of modular hip taper connections and presents a new classification system regarding the surface finish. (10.1016/j.arth.2017.04.027)
  • [L4] Following primary THA, patients with a history of SOT are at increased risk of 90-day medical complications but not 2-year surgical complications or revisions relative to patients without SOT. (10.1016/j.arth.2021.08.027)
  • [L3] Nonelective total hip arthroplasty patients without these risk factors may be safely discharged to home. (10.1016/j.arth.2017.03.042)
  • [L1] Increasing age and history of cardiac disease increases the risk of cardiac complication after total hip arthroplasty and total knee arthroplasty. (10.1186/s13018-018-1058-9)
  • [L3] Both the Clavien-Dindo classification and Comprehensive Complication Index appear valid and applicable to patients undergoing total joint replacement. (10.1302/0301-620x.107b1.bjj-2023-1400.r2)
  • [L5] Magnetic resonance imaging can be used to directly evaluate the integrity of metallic components and detect occult fractures of the femoral component after total hip arthroplasty, even when plain radiographs are normal. (10.2106/00004623-200401000-00024)
  • [L5] Modern MRI techniques are the most important tool in the workup of the patient suspected of having an adverse tissue reaction after hip arthroplasty. (10.1016/j.arth.2020.01.009)
  • [L4] Most patients with a metal-on-metal total hip replacement who do not undergo early revision have normal MRI scans. (10.1302/0301-620x.95b8.31377)
  • [L3] Routine postoperative radiographs may be of limited utility in the asymptomatic patient in the first year following elective primary THA. (10.1016/j.arth.2022.12.030)
  • [L4] The combined imaging diagnostic criteria for aseptic loosening of the acetabular cup after total hip arthroplasty demonstrate superior diagnostic efficacy compared to single imaging parameters. (10.1186/s12891-025-08607-x)
  • [L3] Primary THA can be a reasonable treatment modality for patients failing nonoperative treatments given suboptimal outcomes with hip arthroscopy in the setting of early arthritis. (10.1016/j.arth.2024.07.038)
  • [L3] Surgical interventions, particularly THA, are the primary modality of treatment, with limited use of other surgical and nonsurgical management. (10.1016/j.arth.2025.06.002)
  • [L2] Both protocols provided adequate pain control after total hip arthroplasty; the nonnarcotic pain management protocol resulted in significantly decreased opioid consumption and fewer adverse effects. (10.1016/j.arth.2010.01.003)
  • [L3] Eighty-five percent of native hips survived; the median time to THA was 14 months. (10.5435/jaaos-d-20-00517)
  • [L4] There was no significant radiographic evidence of failure at a minimum of 20 years after THA. (10.1016/j.arth.2021.11.028)
  • [L4] Nonagenarians undergoing primary THA had substantial mortality rates at 90 days (6%) and 1 year (8%). (10.1016/j.arth.2020.10.040)
  • [L4] The use of routinely available preoperative radiology reports provides promising potential to help screen suitable candidates for THA, but not for TKA. (10.1302/0301-620x.106b7.bjj-2024-0136)
  • [Paper] Peri-operative continuation of aspirin treatment in patients undergoing elective primary THA did not increase perioperative complications or mortality compared to the non-aspirin-treated patients. (10.1007/s00402-020-03629-7)
  • [L4] Nonoperative management of IPI after THA may fail to provide long-term resolution of symptoms. (10.1016/j.arth.2025.04.056)
  • [L5] Capsular closure is superior to non-repair, with patients having unrepaired capsules being 6.8 times more likely to require total hip replacement. (10.1016/j.arthro.2019.04.003)
  • [L4] A large majority (77.5%) of Hip Society surgeons believe the direct anterior approach lacks sufficient evidence to warrant its use due to the lack of RCTs showing superiority and reports of higher complication rates. (10.1302/0301-620x.102b7.bjj-2019-1493.r1)
  • [L4] A customized, aggressive regimen of noninvasive and invasive therapeutic modalities reduced symptoms and restored function in 92% of patients with functional problems after total hip or knee arthroplasty. (10.2106/jbjs.e.00628)
  • [L4] Our novel hip implant detection technique accurately identified 9 radiographically similar implants. (10.1016/j.arth.2024.02.001)
  • [L3] The 83.5% 20-year survivorship of this initial series surpasses that of total hip arthroplasties in use 20 years ago in these young patients, suggesting satisfactory lifelong durability of the device for almost all of the remaining patients. (10.1302/0301-620x.103b7.bjj-2020-2256.r1)
  • [L3] MRI can effectively diagnose posterior capsular disruption in patients who have undergone THA via a posterior approach. (10.5435/jaaos-d-18-00655)
  • [L3] This acetabular component demonstrates a favorable and safe clinical and radiological outcome with over 15 years of follow-up. (10.1016/j.arth.2021.06.016)
  • [L3] Using digital radiography in conjunction with strict impingement testing allows for predictable cup placement in total hip arthroplasty, positioning the acetabular component within the desired target zone in 97.8% of cases. (10.2106/jbjs.16.01501)
  • [L4] At intermediate-term follow-up, clinical and radiographic results are favorable after alternative-bearing THA in patients younger than 21 years. (10.1016/j.arth.2011.04.042)
  • [L5] Intraoperative imaging with trial or final components in place is helpful to rule out excessive limb-length discrepancy and to confirm proper component sizing and position in difficult primary total hip arthroplasty or revision situations. (10.2106/jbjs.l.00433)

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[101] Primary Total Hip Arthroplasty Outcomes for Labral Tears are Comparable to Advanced Osteoarthritis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.07.038

[102] Epidemiology, Management, and Systematic Review of Surgical Trends for Patients Who Have Osteonecrosis of the Femoral Head. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.06.002

[103] A Prospective Evaluation of 2 Different Pain Management Protocols for Total Hip Arthroplasty. The Journal of Arthroplasty. 2010. DOI: 10.1016/j.arth.2010.01.003

[104] Survivorship of the Hip Joint After Acetabulum Fracture. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-00517

[105] Long-Term Results of Alumina Ceramic-On-Ceramic Bearings in Cementless Total Hip Arthroplasty: A 20-Year Minimum Follow-Up. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2021.11.028

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[117] MRI Evaluation of Posterior Capsular Dehiscence After Posterior Approach Total Hip Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00655

[118] Long-Term Outcomes of a Titanium-Encased Ceramic Liner Total Hip Arthroplasty (15 to 21Year Results). The Journal of Arthroplasty. 2021. DOI: 10.1016/j.arth.2021.06.016

[119] Digital Radiography in Total Hip Arthroplasty. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.16.01501

[120] Modern Total Hip Arthroplasty in Patients Younger Than 21 Years. The Journal of Arthroplasty. 2012. DOI: 10.1016/j.arth.2011.04.042

[121] Limb-Length Discrepancy After Hip Arthroplasty. The Journal of Bone and Joint Surgery-American Volume. 2013. DOI: 10.2106/jbjs.l.00433

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Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.