1. “Cementless fixation is always superior in modern arthroplasty.”
Myth: Uncemented implants provide better long-term outcomes in all patients.
Reality: Cementless fixation requires good bone quality and metaphyseal support. In osteoporotic or elderly patients, cemented stems show lower periprosthetic fracture and early revision rates.
Fixation method should match bone biology, not surgeon preference.
2. “Dual-mobility cups eliminate all risk of dislocation.”
Myth: Dual-mobility (DM) constructs are fully protective against instability.
Reality: DM cups reduce, but do not eliminate, dislocation risk. Malpositioned components, poor soft-tissue tension, or abductor deficiency can still cause failure.
Stability begins with biomechanics, not implant geometry.
Myth: Technology guarantees precision and better function.
Reality: Robotic and navigated systems improve accuracy of alignment, but functional and survival benefits remain unproven in large-scale data. They add cost and time without necessarily improving satisfaction.
Precision ≠ Perfection.
4. “You should always restore the ‘anatomic’ joint line and alignment.”
Myth: Mechanical restoration equals clinical success.
Reality: Functional alignment — respecting soft-tissue balance and native kinematics — often yields superior outcomes. Over-correction may increase wear or instability.
The goal is a stable, functional envelope — not a textbook angle.
5. “All painful arthroplasties are infected until proven otherwise.”
Myth: Any postoperative pain should trigger a full infection workup.
Reality: While infection must be excluded, pain can also result from component malrotation, metal hypersensitivity, referred spine pain, or iliopsoas impingement.
Use a structured diagnostic algorithm (MSIS criteria) before reoperating.
6. “Periprosthetic joint infection (PJI) is mainly a surgical complication.”
Myth: PJI reflects poor surgical technique.
Reality: Most PJIs arise from hematogenous seeding or host-related factors (diabetes, immunosuppression, poor skin integrity).
PJI prevention is multidisciplinary — perioperative glucose control, nutrition, and skin optimization matter.
7. “Early postoperative physiotherapy always improves implant longevity.”
Myth: Aggressive rehabilitation speeds recovery.
Reality: Excessive early load or forced motion can jeopardize soft-tissue healing, especially after revision or constrained implants.
Rehab should be guided by fixation type and intraoperative stability.
8. “Metal allergy is a common cause of painful arthroplasty.”
Myth: Nickel or cobalt allergy frequently causes chronic pain or implant loosening.
Reality: True hypersensitivity reactions are rare (<1%) and diagnosis remains one of exclusion. Routine allergy testing before THA/TKA is not recommended.
Rule out mechanical causes before immunologic speculation.
9. “Revision surgery always provides worse outcomes than primary arthroplasty.”
Myth: All revisions result in inferior function and satisfaction.
Reality: While complex, outcomes depend on indication, soft-tissue envelope, and implant choice. Early, well-planned revisions (e.g., aseptic loosening, instability) can yield excellent function.
Timely, principle-based revision can restore function nearly to primary levels.
10. “All arthroplasty patients should receive the same thromboprophylaxis.”
Myth: One size fits all for VTE prevention.
Reality: Risk-stratified approaches are safer. Low-risk patients benefit from aspirin-based regimens, while high-risk cases (revision, obesity, cancer, immobility) require LMWH or DOACs.
Balance thrombosis prevention with bleeding risk.
Key Takeaways
Cemented stems remain essential in fragile bone.
Dual-mobility and robotics are tools, not cures.
Alignment and soft-tissue balance outweigh mechanical angles.
Holistic infection prevention > intraoperative sterility alone.
Tailored rehabilitation and patient-specific care drive success.
References :
Abdel MP et al. J Bone Joint Surg Am. 2023;105(7):612–22.
Lewis PL et al. J Arthroplasty. 2024;39(1):45–53.
Gonzalez-Martin D et al. Eur J Trauma Emerg Surg. 2023.
Haddad FS, et al. Bone Joint J. 2024;106-B(5):543–58.
Parvizi J, et al. Clin Orthop Relat Res. 2021;479:985–99.