Myths and Misconceptions in Arthroplasty

Common Myths and the Truth Behind Them

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.

3. “Robotic and navigation-assisted arthroplasty always improves outcomes.”

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 :

1. Abdel MP et al. J Bone Joint Surg Am. 2023;105(7):612–22.

2. Lewis PL et al. J Arthroplasty. 2024;39(1):45–53.

3. Gonzalez-Martin D et al. Eur J Trauma Emerg Surg. 2023.

4. Haddad FS, et al. Bone Joint J. 2024;106-B(5):543–58.

5. Parvizi J, et al. Clin Orthop Relat Res. 2021;479:985–99.