The International Hip Society Supplements 2025

Listen to Andrew Duckworth and Fares Haddad discuss the International Hip Society Supplements published in The Bone & Joint Journal and Bone & Joint Open in May and June 2025.

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Transcript

[00:00:00] Welcome everyone to our BJJ podcast series. I'm Andrew Duckworth and a warm welcome back to you all from your team here at The Bone & Joint Journal. As always, we'd like to thank you all for your continued comments and support, as well as offering a big gratitude to our many authors and colleagues who take part in our series that highlights just some of the great work published by our authors each month.

For this edition we'll discussing the May and June supplements of the BJJ that included 26 highlight papers from the International Hip Society meeting that took place in Athens in 2024. We'll give you a brief overview of the society, the work it does, and how we here at the Journal hope this is benefiting you as our listeners and readers, we also aim to give you a behind the scenes insight into how the studies within the supplements have been reviewed and chosen, as well as offering a brief discussion on a few select papers.

So with that in mind, I have the pleasure of being joined again by our Editor-in-Chief at the BJJ, Professor Fares Haddad. Prof, great to have you back with us. Andrew. Thank you. And thank you for doing this. So, Prof for our listeners, could you maybe give us a brief overview of the International Hip Society for those who are not familiar with it and how, how it sort of came about and what role it plays?

Sure. So the International Hip Society is probably [00:01:00] not well known by most of our listeners in that it is a closed society that reaches the milestone of its 50th birthday next year. It is a society that has a maximum of a hundred active members at any one time, and by an active member, I mean someone under 65 in clinical practice.

If a member goes over 65, that frees up a slot for a new member. And it tries to encompass the best and most productive hip academics and surgeons from all over the world. So as to bring a global perspective to hip surgery. The, the idea really started with Frank Stinchfield, Maurice Muller and John Charley 50 or so years ago to set up an international exchange.

Where the ideas that flourish in the UK, in the United States and Europe, in a Australasia and in the rest of the world, can be shared and disseminated amongst colleagues. And [00:02:00] the, the platform that was created proved to be incredibly successful. You know, Frank Stinchfield led it to begin with, you know, most famously, John Charney refused to be president and wanted others to run it.

You know, Charnley was busy doing his own thing. And then, so it started with Stinchfield and Mueller, and then it has worked its way through since then. So it's actually a, it's always been a small, very select group to give you an idea, you know, right at the very beginning from the UK we had Mike Freeman and George McKee you know, from Europe.

We had Postel from USA, we had Sarmiento, Philip Wilson, Nas Eftekhar. And of course Bill Harris, who suddenly became a, a big force within the society and with the recent death of Harlan Amstutz a couple of years ago, Bill Harris is the only living originator still with us from the, from the original crew. So this is really from the birth of hip replacement surgery going all the way through.

Now, of course, the society now covers hip preservation fractures, all [00:03:00] the other aspects of hip surgery. There's a rolling set of meetings, so the society will meet two out of every three years, and a presidential term is typically a three-year term. So to give you an idea, we started working at the Journal with the International Hip Society a few years ago, and,

around 2014 when John Callaghan was the president from 2014 to 2017, and, and John brought one of his meetings to London, another one in Chicago. Then Henrik Malchau took over. More recently, it's been Dan Berry and I've recently, after the Athens, Athens meeting had the great privilege of becoming the president of the society.

So the Athens meeting was really under the leadership of Professor Dan Berry from the Mayo Clinic, and was was a wonderful meeting that he ran to follow on from his Boston meeting. And the society has had a year off. The supplement is published this year based on papers from last [00:04:00] year. And then next year we move on to a meeting in Melbourne.

Our, our first one in a Australasia that I'll be chairing. And then we come back to London in 27 before I hand on the reins to Steve McDonald from the other London, London, Ontario in Canada. That's a, that's really interesting what, I mean, what a, what a what a history Prof in terms of where that society comes from.

And those are some pretty big names from where it all originated from, like you say. And, and obviously that's how our collab sort of, I suppose that's how our collaboration with them came about. And what do you. How do you see the benefits of that? You know, we've done this with other societies before, but what for, for the IHS in particular, what do you feel the benefits are for the journal and for our, our readers?

So you know what the Journal wants, putting my journal hat on for the moment is the best papers, you know? Mm-hmm. We would like those people who are doing good research, who are shifting our thinking, who are, you know, translating what we do and innovating. To be publishing their best work in the journal.

And by the nature of the International Hip Society being what it is, people tend to bring [00:05:00] their best work to that meeting in order to discuss it. Because remember, this is a closed forum. You can really have honest and open discussion amongst your peers. You know, there are no registrars, there are no fellows, there's no industry.

This is you and your peers having a really serious discussion about the current state of hip surgery and what we're doing to improve it, what challenges we face, and how we are going to resolve those. Mm-hmm. And so given the aims of the International Hip Society are to educate and disseminate knowledge in hip surgery, and those are shared by the Journal, this is an opportunity for us to get good papers from key authors internationally.

And also on behalf of the International Hip Society to disseminate the good work of the society to the rest of the world. At the end of the day, The Bone & Joint Journal has a very international, very broad readership, and it's an ideal platform. So if you like, with both of my hats on. This is an ideal situation.

We want the best papers in the Journal. The International [00:06:00] Hip Society would like to have its proceedings read by a wide community and the best papers seen in the best journals where it will have a wide, the widest readership and the greatest impact. Yeah, and to that end is probably worth saying, our readers may have been slightly confused by it this year in that there were two supplements in The Bone & Joint Journal, but in fact there were also some additional papers each of those two months in Bone & Joint Open.

Yeah. What we've done really is made sure that those papers that are getting into the journal are not getting an easy ride. They're essentially going through a very robust review process, being reviewed both by our standard reviewers and reviewers from International Hip Society. Those that are of the highest quality will be in the BJJ and those that are methodologically sound useful information, but perhaps don't fit into the, the high bar that the BJJ puts for, for its manuscripts will go into BJO and overall, the sum total [00:07:00] will be the product of the IHS meeting in Athens. That's really proven. I think that's, that's a really important point, isn't it? To say that actually because these are supplements, it doesn't mean that they are not the quality of the BJJ, they, they have to hit that, that bar that the BJJ set.

That's correct, isn't it? Yeah, they, they go, so essentially they go through, if anything, a slightly more robust process in that there are more reviewers per paper and they go through our primary editing process. Mm-hmm. Which I think is fundamental to what we do at the journal, which is when a paper is accepted, it is always rewritten by a couple of our primary editors, our author, orthopedic surgeons, who essentially reformat

the, the, the paper, both in terms of the language and the structure to make sure anybody can really understand it and take it away in a very crisp and clear way. Yeah, absolutely. And so if we move on to the supplements themselves, just to have sort of a, have a, you know, a broad brush and look over them, what do you feel are the core or topical themes of the papers this year that have really stood out to you?

So, so the, you know, the Athens meeting was [00:08:00] interesting because it covered a very, very broad area. So there were preservation work, fracture work, and arthroplasty and revision work. I think that there were some key papers for people to look out for. So, you know, one of the big advances in hip surgery in the last 20 years has been highly cross-linked polyethylene and, you know, Peter Devane presented

the long-term data from thier, RCT, and that's really been a, a game changer in, in our world. I think highly cross-linked polyethylene has been a huge, huge advance. There's really interesting work going on now outside the International Hip Society, but also within it on periprosthetic fractures and, and in particular recognising and understanding that relationship between stem type

and technique to a certain extent, and periprosthetic fracture. So we saw some work from David Beverland. Again, looking at the, the differences between polished tapered stems and cementless stems in periprosthetic fracture incidents in [00:09:00] his very large volume practice. We saw some really nice work from Seb Lustig

from Leon comparing their collared and collarless stem, and again, showing a protective effect of a collar. And, and just to bring it around as you'd expect from a, a, a, a, sort of a very well-developed group Rafa Sierra presented the biomechanics that back this up. And then you could link it all back up to registry data to show, for example, in the Swedish registry that the, the, you know, the fractures you get with composite beam stems are different from the fractures you get with polished tapered stems.

So it kind of squares the circle from that point of view in our understanding from that perspective. There's also, there was some really good PJI work and often when you've got a, a closed group of expert like this, you can ask those difficult questions people don't dare to ask. So, you know, what about intraarticular antibiotic infusions?

What is their role? So there's an interesting, you know, paper from Kristoff Corten, you know, he did some [00:10:00] really nice work on using intraarticular antibiotics, you know, following on from the great work of Leo Whiteside that we published in the Journal many years ago.

But that was, that was presented I in, in Athens. A couple of other highlights for me are really interesting paper from George Haidukewych looking at CT scans and periprosthetic fractures around cemented stems and asking the question, does the CT tell me whether this stem is well fixed or not? No, of course.

I'll let, I'll let our readers read the paper, but it doesn't. But two, two other quick things for people to, to, to look out for or a few other quick things. I think Dan Berry and Matt Abdel did a nice paper on primary arthroplasty and femoral deformity. That's really worth thinking about in terms of planning.

You know, if you look at our registry. That femur, that deformed femur still counts as a primary hip, the same as the bog standard primary hip that you're doing in an HVLC. So I think we've gotta look at those carefully. And of course, we had a highlight of Reinhold Ganz, you know, one of the icons of hip surgery [00:11:00] presenting on combined femoral and acetabular osteotomy.

Otherwise, you know, I hope people will go to the supplements. The, the other themes really were around short stay surgery, day-case surgery techniques. And of course a lot about revisions. If you bring a, a group of high volume hip surgeons together, you discover new forms of complexity and new ways of doing big revisions.

It's just to go back to a few of those points Prof in terms of the periprosthetic fractures, that's certainly something that we have seen an explosion in the literature of. And I think it's probably related to maybe an explosion of work that we are now seeing as well. And that is something we are constantly, it's a constant theme now, isn't it?

And it's rare to get a, an addition, whether it be the BJO or the BJJ each month. There isn't something about periprosthetic fractures. Indeed. And you know, partly as you fix some failure modes like wear and osteolysis, you discover others. Yeah. A and also you know, a a as we get, you know, less instability because we're using large heads, we're using dual mobility, so suddenly the focus comes onto other things.

[00:12:00] So of course, infection remains important, but periprosthetic factors are gonna be one of the key areas that are gonna challenge us in terms of volume and in terms of management in future. But this whole area has been fascinating to me because you know, for example, our registries weren't picking up the periprosthetic fractures that were fixed as opposed to being revised.

Yeah. And that's been an important learning point that we've learned from in the UK, but not necessarily all registries are, are capturing. So I think the, the, the whole, the whole arena of periprosthetic fracture after primary hip arthroplasty is an important one as is late periprosthetic fracture after hip arthroplasty

'cause that's the epidemic that's gonna hurt the next generation. Absolutely. And just I noticed something you mentioned and when you were talking about PJI in the editorial about the report report to the, it was Villa et al, I think reported the results of the 1.5 stage revision strategy.

What were your thoughts on that? Yeah, no, so I, I'm, I'm fascinated by 1.5 'cause I, I think the, [00:13:00] this is a community that is scared to do single-stage revision and is doing a form of single stage revision and just hoping for the best. And I think I'm, I think we've made an impact. Over the last ten or 15 years in terms of popularising single-stage revision and that that's not because just it's a passion for many of us in the UK.

This is patient-centered care. Yeah. If, if, if you ask a patient what they would like, they really would hate the idea of having two operations if they could have just one and the data would say in the right hands. You can do it in one procedure. It's a longer procedure, and it is demanding for the surgical team, and it requires multidisciplinary support.

So for me, 1.5 is a fad at the moment. I think there are dangers to these spaces that are poorly fixed, that are kept in and I think it's something that should be evaluated properly in infection centres, but, you know, right, right now I'd much rather be people thinking about, is this patient a candidate for a single stage?

Let's do a really good single stage rather [00:14:00] than hedging in the middle of a single- and a two-stage. That's interesting. And, and just finally, well, one thing that's maybe wrongly stood out to me maybe my ignorance potentially, but not as much as I would've anticipated to be about robotic hip surgery. Is that, is that something that's just we just growing with time with that?

I mean, what, what's your thoughts on that in terms of the literature and where we are at and where we need to be? No. So, so I think it's, it's a great question and it's a good insight on your part. It, it's, this is a hip meeting and therefore robotics probably hasn't had the foothold quite yet that it has in the knee.

Although we are seeing more and more work in this area because the knee really was the area of desperate need, and that's where we've seen the greatest growth. I think robotics has a great deal to offer in the hip. We've seen some randomised studies in the Journal. There are others you know, currently finished recruiting that are about to report, which would be interesting.

And, and you know, the, the, the hip is not as straightforward as people imagine, particularly when we start to understand the spinopelvic [00:15:00] relationship. And, you know, that's when you really need computers to help you define what is the optimal target for each and every patient. So I, I still think for each patient there is a right offset.

There's a right version. Yeah. There's a, an appropriate acetabular position for them at that stage in their life which has to factor in all those things. So I think we'll see more robotics. It just so happens in that particular meeting. Yeah. There, there wasn't that much. The other interesting thing about robotics, of course, in the hip is we've kind of done it upside down in orthopaedics compared to cavitary surgery.

In cavitary surgery, the robots have been used to do the really complex things like rectal cancers that we could not do easily open. Mm-hmm. In hip and knee arthroplasty we've started with the straightforward cases. Yeah. And it's now that robotics is offering us a solution for revisions. Yeah. And the really complex cases that is really going to be interesting and that's going to be, so I think we'll see.

I, I would bet when we [00:16:00] look at the proceedings of the Melbourne meeting mm-hmm. In late 26, early 27, we will see more robotics. Absolutely. And, and just to finish up on that point about revision, do you think, I mean, one of the common, you know, we've done various podcasts about, you know about the role of, of robotics both in hip and knee in terms of, in the revision setting.

Do you think that's potentially where, you know, one of the big questions is always, is it gonna be cost effective in the end? You know, are we actually gonna show a difference in an operation which is already ex exemplary in, in many ways? Is revision where we might see that benefit, because if it has, it gives us enough of a leap, we might see that, that that benefit both in terms of the patient, but also in terms of cost.

You think it's, it's a good question. I mean, I think we'll see a benefit in primaries. Yeah. In the long run. If we, you know, if we do it properly and look at it in the big set, you know, in, in, in the centres across a large enough period of time to see reduction in complications, reduction revisions. That's, that's my bias, I guess, but that's what I'm seeing going around the world, watching what people are [00:17:00] doing in, in that, you know, once you know the target, you know you're gonna hit that target.

Yeah. Yeah. I, I think we will see a greater benefit in revisions, in, in making complex solutions more straightforward. The trouble with measure measuring that and its cost effectiveness is. In, in, you know, really in, in relation to the heterogeneity of our revisions, it's very difficult to standardise.

Yeah. And you know, one of the big things about revisions is the cost of the implants. So, for example, there's a danger that if you push too much towards customised implants, we might make revisions more. Yeah. More expensive. Yeah. So if we can use computers and robotic arms to bring down the complexity, use hemispheres with augments, use cages.

Use something that isn't a custom that may in itself create a saving and make it cost effective. If we can make the revision last longer even better. But I think this is gonna keep us working hard and collecting data for the next decade or more. Absolutely. Absolutely. Well, Prof, that's all, we have time for.

Thank you so much for taking the time to, for, [00:18:00] to join us and and congratulations to you and the, the, the team at the Journal as well as the IHS team on the, and excellent supplements. There's some really interesting papers in there. And I do encourage our listeners to go and take a look. To our listeners

I do hope you've enjoyed joining us and feel free to post or tweet about anything we've discussed here today. And thanks again for listening. Take care everyone.