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Occult pelvic fractures following primary total hip arthroplasty: A retrospective CT-Based cohort study
⁎Corresponding author: Johannes M. van der Merwe. jov777@mail.usask.ca
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Received: ,
Accepted: ,
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Abstract
Postoperative pelvic fractures are a rare but under-recognized complication of total hip arthroplasty (THA), particularly in the setting of cementless, press-fit acetabular components. This study aimed to determine the incidence, radiographic detectability, risk factors, and early clinical impact of occult pelvic fractures following primary THA.
In this retrospective cohort, 60 primary THAs (59 patients) performed by a single surgeon at a tertiary center between June 2024 and September 2025 were evaluated. All patients underwent posterolateral THA using a hemispherical uncemented acetabular component with routine screw augmentation. Immediate postoperative radiographs and pelvic CTs were obtained, and images were independently reviewed by a dedicated musculoskeletal radiologist and a second radiologist to identify pelvic fractures and assess agreement. Demographics, comorbidities, surgical factors, and early postoperative outcomes were recorded. At 6 weeks, pain (VAS), Oxford Hip Score, and EQ-5D–based quality-of-life scores were collected. Multivariable logistic regression explored associations between fractures, risk factors, and early outcomes.
Occult pelvic fractures were identified on CT in 22 of 61 hips (36.1%), whereas radiographs detected fractures in only 10% of cases. Fractures most commonly involved the ilium, followed by the posterior column and pubic rami. Interobserver agreement for fracture detection on radiographs was high by percentage (90%). No individual patient-, operative-, or early postoperative factor was independently associated with fracture occurrence. At 6 weeks, there were no statistically significant differences in pain scores, functional PROMs, or use of assistive devices or opioids between patients with and without occult fractures.
We found that occult pelvic fractures were common after a THA, but did not lead to worse functional or clinical outcomes. In addition, we determined that postoperative radiographs dramatically under-detect postoperative acetabular fractures. We were unable to find independent predictors (patient-, operative- and postoperative factors) of postoperative acetabular fractures.
Keywords
Total hip arthroplasty
Pelvic fractures
Occult fractures
Postoperative fractures
CT detection of fractures
1 Introduction
Postoperative pelvic fracture is a rare but serious complication of total hip arthroplasty (THA). These fractures are expected to occur in less than 5% of all THA's.1,2 Berry et al. reported an intraoperative fracture rate of 0.3% with cemented femoral stems,1 and Abdel et al. reported a rate of 0.23% with cemented stems,2 both studies evaluating large patient groups. The rate increases approximately fourteen-fold when uncemented fixation is used.2,3 However, most fractures during THA occur during femoral component placement, often at the calcar region.2 The rate of iatrogenic pelvic fracture is not well established in the literature.4 (see Table 1, Fig. 1)
| Variable | Mean value |
| Age (years) | 71.65 ± (52 to 87) |
| Sex | |
| Male | 24 (40%) |
| Female | 36 (60%) |
| Operative Side | |
| Right | 29 (48.3%) |
| Left | 31 (51.7%) |
| Risk Factors | |
| BMI (mean) | 30.7 ± (17.8 to 55.0) |
| Charleston Comorbidity Index (mean) | 4.0 ± (1 to 10) |
| Osteoporosis, n (%) | 11 (18.3%) |
| Type 2 Diabetes Mellitus, n (%) | 9 (15%) |
| Smoker, n (%) | 11 (18.3%) |
| Thyroid disease, n (%) | 9 (15%) |
| Glucocorticoid therapy, n (%) | 13 (21.7%) |
| Alcohol use, n (%) | 6 (10%) |
With an aging population, the rate of total hip arthroplasty (THA) is expected to increase substantially. It is expected that THA volume could increase to 121–200% by 2050 compared to 2023.5 Despite an increasing trend in hip arthroplasty among younger patients,6,7 most patients undergoing total hip arthroplasty remain older than 65 years of age.1,7 Women are approximately one and a half to two times more likely to undergo hip replacement than men1,7 and are also three to four times more likely to develop osteoporosis.8 Females are almost twice as likely to have an intraoperative fracture.3
Fractures of the acetabulum may be associated with postoperative groin pain 9, 10. The increased popularity of cementless, press-fit acetabular cups may increase the rate of intraoperative acetabular fractures, and the number of clinically detectable fractures may underrepresent the actual number of occult acetabular fractures.4,9,10 Risk factors for acetabular fractures include cementless press-fit components, increased age, female sex, small acetabular component size, low body mass index, osteoporosis or metabolic bone disease, and rheumatoid arthritis.4,9,11,12 Evaluation of acetabular fractures during THA can be difficult, and plain radiographs likely underestimate their incidence. Recent studies, including a study by Hasegawa et al., have estimated a fracture rate of 8.4%, confirmed by postoperative computed tomography (CT).13 A more recent study by Chun et al. reported an even higher incidence of 17.2% (20). These fractures were most commonly found in the superolateral wall.11,13 They were deemed clinically insignificant based on postoperative visual analog scales (VAS) and functional scores, such as the Harris Hip Score (HHS).11,13 Both studies used preoperative and postoperative images to localize injuries to five possible locations: medial wall, posterior wall, superolateral wall, anterior wall, and other locations.13 However, none of these studies involved assessment by a dedicated musculoskeletal radiologist.
Our study is a prospective cohort study designed as a follow-up to these aforementioned studies evaluating occult pelvic fractures using CT, the preferred method of evaluation of these injuries. We utilized expert evaluation by a dedicated musculoskeletal radiologist to assess interobserver reliability of injury evaluation and evaluate the correlation of their detection with plain radiographs. Common risk factors for periprosthetic fractures were identified in the patient population. Intraoperative factors, including component size, use of an acetabular screw, and intraoperative complications, were recorded. Radiographic information, such as cup inclination and anteversion, was noted. Our study assessed patient-reported outcome measures (PROMs) and functional outcomes (early weight-bearing status and use of assistive devices) at early follow-up (6 weeks) to evaluate the clinical relevance of these iatrogenic injuries and their impact on early mobilization and rehabilitation.
2 Methods
The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Board (Bio 5650). Consent obtained from all patients to participate in the study.
A total of 60 total hip arthroplasties (n = 59 patients) were completed from June 2024 to September 2025. Each patient received a primary THA performed by a single adult reconstruction surgeon at a single tertiary teaching hospital. Demographic information, including age, sex, Charleston Comorbidity Index (CCI), BMI, smoking status, and medical comorbidities, was recorded.
All patients received preoperative plain radiographs before undergoing THA surgery through the posterolateral approach. Preoperative CT scans were not performed to limit resource utilization and patient radiation exposure. The G7® Acetabular System (Zimmer-Biomet, Warsaw, Indiana) was used in all cases. The acetabulum was underreamed by 1 mm in each case, and the cup was placed in an uncemented, press-fit fashion in accordance with the product guide. The cup was placed in approximately 45 degrees of coronal tilt and 25 degrees of anteversion, and acetabular screw fixation was used in each case. Stability was tested intraoperatively. Intraoperative complications, including periprosthetic fracture, blood loss, and systemic complications, were recorded.
Postoperatively, each patient received a plain radiograph to assess component positioning. Before their discharge from the hospital (1–5 days), each patient received a CT pelvis to evaluate for occult acetabulum fracture. A radiologist reviewed each CT scan, and the reports were uploaded to a Picture Archiving and Communications System (PACS), as is standard practice in our centre. The postoperative plain radiograph and CT scan were later independently evaluated by a fellowship trained musculoskeletal radiologist, assessing specifically for pelvic fracture. Concordance between the evaluations was recorded. Other parameters, including cup inclination and anteversion, were evaluated on the CT. Pelvic fractures and their associated location were recorded. Incidental findings were also noted.
Patients were allowed to weight-bear postoperatively. They began early mobilization with physical therapy and were discharged when deemed safe to mobilize without mobility devices. Fifty-five patients were reviewed at a standard six-week follow-up appointment. A patient completed a visual analog scale (VAS) to assess post-operative pain, as well as a PROM survey, including the Oxford Hip Score and the estimated Quality of Life Score (EQ-5D). Other outcome measures, including weight-bearing status, use of assistive devices, and use of narcotics, were also recorded.
Multivariate logistic regression was used to examine the association between fractures and recorded risk factors.
2.1 Statistical analysis
Variables were analyzed on a complete-case basis (rows with missing values in a given analysis were excluded). Descriptive statistics summarized continuous features—reporting mean, standard deviation, minimum, and maximum, as well as counts with percentages for categorical variables. Group comparisons between used parametric or non-parametric tests as appropriate (Welch's t-test when assumptions held, otherwise Mann–Whitney U) for continuous variables, and χ2 tests or Fisher's exact tests for categorical variables. To evaluate independent associations with fracture status, we fit a multivariable logistic regression with standardized predictors, reporting adjusted odds ratios with 95% confidence intervals and two-sided p-values. Interrater reliability for selected categorical ratings was quantified by percentage agreement and Cohen's κ.
3 Results
3.1 Demographic data
The mean age of participants was 71 years (range 52–87 years; standard deviation 7.8 years). The mean body mass index (BMI) was 30 kg/m2 (range 17.8–55 kg/m2; standard deviation 6.8). Females comprised 59% of the cohort, and 49.1% of procedures involved right hips.
Regarding comorbidities, the mean Charlson Comorbidity Index (CCI) was 4 (range 1–10; standard deviation 1.5). Osteoporosis was present in 18% of patients (11/61), 21.3% were receiving immunosuppressive therapy (13/61), 14.8% had hypothyroidism (9/61), and 14.8% had type 2 diabetes mellitus (9/61). Additionally, 18% of patients were current smokers (11/61), and 9.8% reported alcohol use (6/61).
3.2 Surgical data
All patients underwent primary total hip arthroplasty with placement of two supplementary acetabular screws. The mean acetabular cup diameter was 56 mm (range, 50–64 mm; standard deviation, 3.1 mm). The mean operative time was 53 min (range, 40–77 min; standard deviation, 8.9 min), and the mean length of hospital stay was 1.5 days (range, 0–5 days; standard deviation, 0.9 days). Two patients (3.3%) experienced intraoperative complications, consisting of small calcar fractures managed with cerclage wire fixation without the need for further intervention.
3.3 Postoperative course
Twenty patients still required assistive devices at their 6 weeks follow up (32.8%). 9.2% were still using narcotics intermittently for pain at their 6 week follow up, while only 8.2% of patients experienced pain at their 6 weeks followup. We calculated the patient reported outcome measures at 6 weeks. The mean Oxford Hip Score (OHS) was 45 (std deviation 6.98; 31–59). The estimated Daily Quality of Life score (Daily QOL) was 79.2 (std dev 14.55; 33–100); the mean Quality of Life (mean QOL) score was 9.6 (std deviation 3.5, 5–19). We did not find a statistically significant difference between the patients that had an occult fracture and the patients that did not have an occult fracture; OHS (p = 0.76); Estimated Daily QOL (p = 0.75); QOL score (p = 0.23).
3.4 Radiographic assessment
Interobserver agreement for radiographically detected fractures on immediate postoperative radiographs was high, with concordant assessments in 90% of cases. After adjustment for the readers' distribution of ratings across categories, the level of agreement was only modest (Cohen's kappa = 0.348).
The two radiologists identified six and four fractures, respectively, on the immediate postoperative radiographs. On immediate postoperative computed tomography, 22 pelvic fractures were identified (36.1%). These included one fracture of the superior pubic ramus, one of the inferior pubic ramus, three involving the posterior column, two involving the anterior column, sixteen involving the ilium, and three in other regions (two supra-acetabular and one inferior acetabular).
3.5 Multivariable regression analysis
We did a multivariable regression analysis and did not find an individual risk factor which was associated with a postoperative acetabular fracture (variables included: alcohol usage, smoking, type 2 diabetes, hypothyroidism, immunosuppressant medication usage, presence of osteoporosis, CCI, BMI, sex, age). (p > 0.005)
In addition, a multivariable regression analysis did not find an intraoperative or postoperative predictor which was associated with a postoperative acetabular fracture (variables included: pain at 6 weeks; using assistive devices, length of stay, surgical time, cup size, laterality of hip). (p > 0.005).
4 Discussion
In the current study the key findings were that occult pelvic fractures were common after a THA, but did not lead to worse functional or clinical outcomes. In addition, we determined that postoperative radiographs dramatically under-detect postoperative acetabular fractures. In regards to our secondary outcome measures, we were unable to find independent predictors (patient-, operative- and postoperative factors) of postoperative acetabular fractures.
We identified a large amount of occult pelvic fractures (36.1%) on the immediate postoperative CT-scan after an elective THA. This was in contrast with the literature where occult fractures occurred in 8–11% of patients.14 Multiple reasons could explain the differences. The two studies differed in baseline characteristics with the current study having an older population (Mean age 71 compared to the literature with a mean age of 60) and a larger mean BMI (mean BMI 30 compared to mean BMI of 23). Multiple large registry studies demonstrate that age above 80 significantly increases the risk of periprosthetic fractures.15 However, multiple studies found that increased BMI is associated with increased risk of overall complications but no association was found between increased BMI and acute postoperative periprosthetic fractures.16,17 In our study we used a hemispherical acetabular component with routine screw augmentation while in the study by Hasegawa et al. multiple cup designs were used and screw augmentation was only performed if deemed necessary.14 The literature has not identified a clear association between screw fixation and occult fractures, but did find that peripheral self locking acetabular cups do carry a 2.6 fold increased risk of occult fractures.14,18 We performed all the THA's in a tertiary high-volume center. The reamers are replaced every year and subsequently we will operate with blunt reamers as the year progresses. The literature is clear that the use of blunt reamers in THA does result in the acetabulum being underreamed.19 Excessive underreaming of 2 mm or more can approach or exceed the yield strength of bone,20 which in turn can explain a higher rate of occult fractures especially in an older population.
The literature is scarce regarding PROMS and occult pelvic fractures following THA's. Banierink et al.,21 found that patients still experienced significant functional impairment with minimally displaced pelvic fractures (Tile/AO type A). They found a 20–30% reduction in QoL compared to age matched populations. This was different to our findings where there was no difference in PROMS between patients with or without occult pelvic fractures. A potential explanation for the different findings is that Banierink et al. included symptomatic minimally displaced pelvic fractures while the fractures in our cohort were discovered incidentally on postoperative x-rays, and might not have produced symptoms substantial enough to influence PROMS.
Hasegawa et al. found that the superolateral wall was the most common location for occult fractures to occur.13 This was followed by the anterior wall, medial wall and posterior wall.13,22,23 Another type of occult pelvic fractures are located near the origin of the superior or inferior pubic ramus.24 In our study we found that the ilium was the most common location followed by the posterior wall. We are unable to explain why there was a difference between our findings and the previous studies. This highlights that occult pelvic fractures are not universal and may be context specific.
In our study we found that postoperative radiographs (10%) did not reliably identify postoperative occult fractures compared to CT scans (36%). This is in concordance with the literature where a large series identified 8.4% of occult fractures on CT scans which were missed on postoperative radiographs.13 Another study concluded a sensitivity of radiographs of only 42.4% for acetabular fractures.25 The American College of Radiology (ACR) recommends CT as the best imaging modality when there is high clinical suspicion for periprosthetic fractures and radiographs are negative or equivocal.26 The ACR recommends only routine postoperative radiographs to evaluate for periprosthetic fractures in select circumstances and not universally for all asymptomatic patients. Certainly, radiographs should still be performed for other reasons (e.g., acetabular cup positioning, leg-length discrepancy, component alignment etc.). Baseline radiographs are recommended for future comparison and for identifying subtle changes over time.27 In addition to standard (AP) pelvis and cross-table lateral hip radiographs, false profile and high-angle oblique/lateral pelvic views can improve detection of pelvic discontinuity and posterior column fractures, particularly when standard AP and Judet views are obscured by hardware. False profile views are particularly sensitive to detect pelvic discontinuity while high-angle oblique views are useful for visualizing the posterior column.28,29 However, additional radiographs do not reduce the need for CT scans to detect these occult fractures.30
In our study 32% of patients still required aids at 6 weeks. This is similar in the literature where one study identified 26% of patients requiring assistive devices at their 6 week follow-up.31 They identified factors such as older age, higher BMI and lower preoperative physical function to be associated with higher likelihood of remaining on assistive devices. Reasons for the higher rate of occult fractures in the current study includes: an older population, higher BMI, longer wait times for surgery with potential deconditioning. We found that 9.2% of patients still required opioids intermittently at their six week followup. Large cohort studies found the rate of continued opioid use at 6 weeks ranges between 8 and 20%.32,33 They determined that opioid-naive patients have the lowest rates, while those with chronic preoperative use may have rates exceeding 30%. Unfortunately, we did not investigate preoperative assistive device usage or opioid usage. This is certainly an area to explore for future studies.
4.1 Limitations
This study has several important limitations. First, it was conducted at a single tertiary, high-volume center with all procedures performed by one adult reconstruction surgeon, which may limit generalizability to lower-volume centers, different surgeons, or alternative surgical approaches and implant systems. The relatively small sample size (60 hips, 59 patients) also reduces statistical power, increasing the risk of type II error, particularly in the multivariable regression analyses where no independent predictors of fracture were identified.
Second, preoperative CT scans were not obtained, so it was not possible to definitively exclude pre-existing pelvic or acetabular abnormalities or subclinical fractures prior to surgery. As a result, all fractures detected on postoperative CT were assumed to be iatrogenic, which may overestimate the true incidence of surgery-related fractures. In addition, the follow-up period focused on early outcomes (6 weeks), which limits the ability to draw conclusions about the long-term clinical impact of occult pelvic fractures on function, quality of life, implant survival, or late complications.
Lastly, patient-reported outcome measures and functional assessments were only collected at a single early postoperative time point, and important preoperative baseline PROMs and functional data (including preoperative assistive device and opioid use) were not available for comparison. This limits the ability to fully assess change over time and to adjust for preexisting impairment, which may confound the observed lack of difference between patients with and without occult fractures. The study may therefore underestimate subtle or delayed effects of occult fractures on recovery trajectories.
5 Conclusion
Even though we found a large number of occult pelvic fractures on CT after a primary THA, these fractures did not affect postoperative function or quality of life. We were unable to identify specific patient-, operative- and postoperative risk factors for these occult pelvic fractures. Radiographs alone substantially underestimated the true incidence of postoperative fractures.
Informed consent
N/A.
Ethical approval and consent to participate
Approved on the August 1, 2023; Bio 5650, Consent obtained from all patients to participate in the study.
Availability of supporting data
All the raw data and materials described in the manuscript is available upon requests to any scientist wishing to use them for non-commercial purposes.
Consent for publication
Not applicable.
Disclosures
The authors have no conflicts of interest to declare.
Ethics statement
Research Ethics Board approval (BIO 5650)
Data available statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Patient and guardian consent
This is not applicable to this study – No identifiable names, images, videos are in the manuscript.
Credit author statement
Conceptualization: Dr Johannes van der Merwe.
Methodology: Dr Johannes van der Merwe, Dr Gavin King, Dr Haron Obaid.
Software: N/A.
Validation: Dr Johannes van der Merwe.
Formal Analysis: Dr Johannes van der Merwe, Dr Gavin King, Dr Haron Obaid.
Investigation: Dr Johannes van der Merwe, Dr Gavin King, Dr Haron Obaid, Michaela Nickol.
Resources: Dr Johannes van der Merwe, Dr Gavin King, Dr Haron Obaid, Michaela Nickol.
Data Curation: Dr Johannes van der Merwe.
Writing - Original Draft: Dr Johannes van der Merwe, Dr Gavin King, Dr Haron Obaid, Michaela Nickol.
Writing – Review & Editing: Michaela Nickol, Dr Johannes van der Merwe, Dr Mars Yixing Zhao.
Visualization: Dr Johannes van der Merwe.
Supervision: Michaela Nickol, Dr Johannes van der Merwe, Dr Mars Yixing Zhao.
Project administration: Michaela Nickol, Dr Johannes van der Merwe, Dr Mars Yixing Zhao.
Funding Acquisition: N/A.
Funding
No funding for the research study.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
References
- Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience. Bone Joint J. 2016;98-b(4):461-467.
- [Google Scholar]
- Incidence and risk factors of intraoperative periprosthetic femoral fractures during primary total hip arthroplasty: 218,423 cases reported to the Norwegian arthroplasty register between 1987 and 2020. Acta Orthop. 2022;93:405-412.
- [Google Scholar]
- Diagnosis and management of intraoperative fractures in primary total hip arthroplasty. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2021;29(10):e497-e512.
- [Google Scholar]
- Global trends in joint arthroplasty: a systematic review and future projections. J Clin Med. 2025;14(22)
- [Google Scholar]
- Utilization rates of hip arthroplasty in OECD countries revised. Osteoarthr Cartil. 2025;33(12):1475-1484.
- [Google Scholar]
- Screening for osteoporosis to prevent fractures: US preventive services task force recommendation statement. JAMA. 2018;319(24):2521-2531.
- [Google Scholar]
- Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am. 2008;90(9):2000-2012.
- [Google Scholar]
- Incidence and outcomes of intraoperative periprosthetic acetabular fractures during cementless total hip arthroplasty: a prospective three-dimensional computer tomography-based study. Int Orthop. 2024;48(3):667-674.
- [Google Scholar]
- Rate- and patient-specific risk factors for periprosthetic acetabular fractures during primary total hip arthroplasty using a press-fit cup. J Arthroplast. 2025;40(12):3315-3323.
- [Google Scholar]
- Periprosthetic occult fractures of the acetabulum occur frequently during primary THA. Clin Orthop Relat Res. 2017;475(2):484-494.
- [Google Scholar]
- Periprosthetic occult fractures of the acetabulum occur frequently during primary THA. Clin Orthop Relat Res. 2017 Feb;475(2):484-494.
- [Google Scholar]
- Incidence and risk factors of intraoperative periprosthetic femoral fractures during primary total hip arthroplasty: 218,423 cases reported to the Norwegian arthroplasty register between 1987 and 2020. Acta Orthop. 2022 Apr 6;93:405-412.
- [Google Scholar]
- A novel method for stratification of major complication risk using body mass index thresholds for patients undergoing total hip arthroplasty: a national cohort of 224,413 patients. J Arthroplast. 2022 Oct;37(10):2049-2052.
- [Google Scholar]
- Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review. Osteoarthr Cartil. 2020 Jan;28(1):31-44.
- [Google Scholar]
- Does intraoperative periprosthetic occult fracture of the acetabulum affect clinical outcomes after primary total hip arthroplasty? Arch Orthop Trauma Surg. 2022 Nov;142(11):3497-3504.
- [Google Scholar]
- Shell design and reaming technique affect deformation in mobile-bearing total hip arthroplasty acetabular components. Proc Inst Mech Eng H. 2017 Aug;231(8):691-698.
- [Google Scholar]
- Factors influencing initial cup stability in total hip arthroplasty. Clin Biomech. 2014 Dec;29(10):1177-1185.
- [Google Scholar]
- What is the long-term clinical outcome after fragility fractures of the pelvis? - a CT-based cross-sectional study. Injury. 2022 Feb;53(2):506-513.
- [Google Scholar]
- Occult intra-operative periprosthetic fractures of the acetabulum may affect implant survival. Int Orthop. 2019 Jul;43(7):1583-1590.
- [Google Scholar]
- Incidence and outcomes of intraoperative periprosthetic acetabular fractures during cementless total hip arthroplasty: a prospective three-dimensional computer tomography-based study. Int Orthop. 2024 Mar;48(3):667-674.
- [Google Scholar]
- Ipsilateral pubic ramus fracture during total hip arthroplasty is not rare: does it matter? Arch Orthop Trauma Surg. 2024 Jun;144(6):2849-2857.
- [Google Scholar]
- The trauma pelvic X-ray: not all pelvic fractures are created equally. Am J Surg. 2022 Jul;224(1 Pt B):489-493.
- [Google Scholar]
- Routine radiographs after total joint arthroplasty: is there clinical value? J Arthroplast. 2021 Jul;36(7):2431-2434.
- [Google Scholar]
- Effectiveness of false profile radiographs in detection of pelvic discontinuity. J Arthroplast. 2012 Aug;27(7):1408-1412.
- [Google Scholar]
- Lateral and high-angle oblique radiographs of the pelvis aid in diagnosing pelvic discontinuity after total hip arthroplasty. J Arthroplast. 2011 Jan;26(1):110-112.
- [Google Scholar]
- Low-dose CT: a safe and effective imaging modality in post-operative pelvic & acetabular fixation. Injury. 2024 Jun;55(6)
- [Google Scholar]
- Early recovery outcomes in patients undergoing total hip arthroplasty through a posterior approach with modified postoperative precautions. J Arthroplast. 2021 Aug;36(8):2817-2822.
- [Google Scholar]
- Trends and predictors of opioid use after total knee and total hip arthroplasty. Pain. 2016 Jun;157(6):1259-1265.
- [Google Scholar]
- Preoperative risk factors for opioid utilization after total hip arthroplasty. J Bone Joint Surg Am. 2019 Sep 18;101(18):1670-1678.
- [Google Scholar]