{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T22:15:28Z","timestamp":1774908928455,"version":"3.50.1"},"reference-count":58,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Symmetry"],"abstract":"<jats:p>Total hip arthroplasty (THA) is commonly performed for conditions like osteoarthritis, avascular necrosis, hip fractures, and hip dysplasia. Complications following THA can result in major proximal femoral defects (MPFD), which are challenging to manage. Megaprostheses provide a solution, offering stability and early weight-bearing, though they present their own challenges. However, maintaining hip symmetry with megaprostheses is challenging in accurately restoring femoral offset, acetabular orientation, and soft tissue tension. These factors can contribute to instability, altered biomechanics, and functional impairment. Therefore, achieving hip symmetry through femoral and acetabular offset, limb length discrepancy (LLD), and center of rotation (COR) is an important consideration. Achieving proper symmetry may improve gait, quality of life, and overall outcomes. This case series includes 10 patients with non-tumoral pathology treated with megaprostheses for complications after THA between 2014 and 2024. Megaprosthesis conversion was performed for sepsis (n = 2), aseptic loosening (n = 4), and periprosthetic fracture (n = 4). Dislocation occurred in 20%, with one case showing restored hip symmetry but dislocating due to trauma and noncompliance. Another case had an LLD of 3 cm, contributing to dislocation. Periprosthetic infection was observed in 20%, managed with a two-stage approach. Although hip symmetry was not fully restored in all patients, strict follow-up and rehabilitation were essential for improving functionality and quality of life. Megaprosthesis is an effective solution for MPFD in non-oncological patients when performed correctly. Restoring hip symmetry is challenging and depends on patient care and compliance, though it is an important factor influencing outcomes.<\/jats:p>","DOI":"10.3390\/sym17030322","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T03:47:46Z","timestamp":1740109666000},"page":"322","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Restoring Hip Symmetry and Its Impact on Outcomes: A Case Series on Megaprosthesis Use in Non-Oncological Patients with Complications After Total Hip Arthroplasty"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7403-1684","authenticated-orcid":false,"given":"Serban","family":"Dragosloveanu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Department of Orthopaedics, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"}]},{"given":"Bogdan-Sorin","family":"Capitanu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"}]},{"given":"Mihnea Nicolae","family":"Moise","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8937-7608","authenticated-orcid":false,"given":"Diana Elena","family":"Vulpe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"},{"name":"Doctoral School, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}]},{"given":"Radu","family":"Josanu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2269-511X","authenticated-orcid":false,"given":"Mihai Emanuel","family":"Gherghe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9991-7052","authenticated-orcid":false,"given":"Emi Marinela","family":"Preda","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"},{"name":"Department of Radiology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}]},{"given":"Romica","family":"Cergan","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"},{"name":"Department of Anatomy, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7676-6393","authenticated-orcid":false,"given":"Cristian","family":"Scheau","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, \u201cFoisor\u201d Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania"},{"name":"Department of Physiology, The \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"ref_1","unstructured":"Varacallo, M.A., Luo, T.D., and Johanson, N.A. (2023). Total Hip Arthroplasty Techniques. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s11999-015-4341-7","article-title":"Complications of Total Hip Arthroplasty: Standardized List, Definitions, and Stratification Developed by the Hip Society","volume":"474","author":"Healy","year":"2016","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00264-007-0364-3","article-title":"Total hip arthroplasties: What are the reasons for revision?","volume":"32","author":"Ulrich","year":"2008","journal-title":"Int. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5199","DOI":"10.1007\/s00402-024-05379-2","article-title":"Septic complications are on the rise and aseptic loosening has decreased in total joint arthroplasty: An updated complication based analysis using worldwide arthroplasty registers","volume":"144","author":"Hauer","year":"2024","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3892\/etm.2020.9346","article-title":"A new perspective towards failure of gamma nail systems","volume":"20","author":"Dragosloveanu","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1007\/s00590-024-03930-w","article-title":"Risk of complications and implant survival of surgical treatment of proximal femoral metastasis: A meta-analysis","volume":"34","author":"Solou","year":"2024","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106","DOI":"10.3892\/etm.2021.11029","article-title":"Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study","volume":"23","author":"Dragosloveanu","year":"2022","journal-title":"Exp. Ther. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"614","DOI":"10.5312\/wjo.v5.i5.614","article-title":"Management bone loss of the proximal femur in revision hip arthroplasty: Update on reconstructive options","volume":"5","author":"Sakellariou","year":"2014","journal-title":"World J. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5371\/hp.2024.36.2.101","article-title":"Management of Severe Bone Defects in Femoral Revision following Total Hip Arthroplasty","volume":"36","author":"Li","year":"2024","journal-title":"Hip Pelvis"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sambri, A., Parisi, S.C., Zunarelli, R., Di Prinzio, L., Morante, L., Lonardo, G., Bortoli, M., Montanari, A., De Cristofaro, R., and Fiore, M. (2023). Megaprosthesis in Non-Oncologic Settings\u2014A Systematic Review of the Literature. J. Clin. Med., 12.","DOI":"10.3390\/jcm12124151"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1007\/s00402-021-04201-7","article-title":"Femoral defects in revision hip arthroplasty: A therapy-oriented classification","volume":"143","author":"Jaenisch","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"38432","DOI":"10.52965\/001c.38432","article-title":"The major proximal femoral defects: Megaprosthesis in non oncological patients\u2014A case series","volume":"15","author":"Zanchini","year":"2023","journal-title":"Orthop. Rev."},{"key":"ref_13","first-page":"348","article-title":"Is Masquelet Technique A Successful Viable Treatment In Reconstructing Large Tumor Bone Gaps in Adolescent and Adult?","volume":"11","author":"Sharma","year":"2023","journal-title":"Arch. Bone Jt. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jbiomech.2018.02.026","article-title":"Masquelet technique: The effect of altering implant material and topography on membrane matrix composition, mechanical and barrier properties in a rat defect model","volume":"72","author":"Gaio","year":"2018","journal-title":"J. Biomech."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kazubski, K., Tomczyk, \u0141., Ciszewski, M., Witkowski, J., Reichert, P., and Morasiewicz, P. (2021). The Symmetry and Predictive Factors in Two-Stage Bilateral Hip Replacement Procedures. Symmetry, 13.","DOI":"10.3390\/sym13081472"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Kirschner, J., Michel, S., Becker, R., Stiebitz, O., Hommel, H., Schulz, R., Daszkiewicz, M., Kr\u00f3likowska, A., and Prill, R. (2023). Determination of Relationships between Symmetry-Based, Performance-Based, and Functional Outcome Measures in Patients Undergoing Total Hip Arthroplasty. J. Pers. Med., 13.","DOI":"10.3390\/jpm13071046"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1016\/j.otsr.2015.11.001","article-title":"Lower limb length and offset in total hip arthroplasty","volume":"102","author":"Flecher","year":"2016","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Esbj\u00f6rnsson, A.C., Kiernan, S., Mattsson, L., and Flivik, G. (2021). Geometrical restoration during total hip arthroplasty is related to change in gait pattern\u2014A study based on computed tomography and three-dimensional gait analysis. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04226-4"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s43019-020-00034-7","article-title":"Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: A critical review","volume":"32","author":"Vaishya","year":"2020","journal-title":"Knee Surg. Relat. Res."},{"key":"ref_20","first-page":"e53717","article-title":"Megaprosthesis for a Rare Case of Bone Metastasis of Thyroid Carcinoma: Case Management and Surgical Approach","volume":"16","author":"Petre","year":"2024","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/00003086-200403000-00023","article-title":"Proximal femoral replacements with megaprostheses","volume":"420","author":"Parvizi","year":"2004","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1007\/s00264-021-05080-8","article-title":"Proximal femoral reconstruction with modular megaprostheses in non-oncological patients","volume":"45","author":"Vertesich","year":"2021","journal-title":"Int. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1186\/s13018-021-02749-z","article-title":"The risk for complications and reoperations with the use of mega prostheses in bone reconstructions","volume":"16","author":"Berger","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1302\/0301-620X.99B3.BJJ-2016-0822.R1","article-title":"Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss","volume":"99-B","author":"Viste","year":"2017","journal-title":"Bone Jt. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s10195-022-00632-z","article-title":"Proximal femoral replacement for non-neoplastic conditions: A systematic review on current outcomes","volume":"23","author":"Pederiva","year":"2022","journal-title":"J. Orthop. Traumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21037\/aoj-20-104","article-title":"Resection and reconstruction of the proximal femur with revision stems: A cost-effective alternative","volume":"8","author":"Bahamonde","year":"2022","journal-title":"Ann. Jt."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.amsu.2020.08.036","article-title":"A modified technique of mega prosthesis revision on non-neoplastic patient: Case report","volume":"58","author":"Prabowo","year":"2020","journal-title":"Ann. Med. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s42836-022-00150-7","article-title":"Apparent trends in the use of femoral megaprostheses: An analysis from the National Joint Registry","volume":"4","author":"Puttock","year":"2022","journal-title":"Arthroplasty"},{"key":"ref_29","first-page":"1715","article-title":"Causes of and treatment options for dislocation following total hip arthroplasty","volume":"18","author":"Lu","year":"2019","journal-title":"Exp. Ther. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1007\/s12178-013-9180-0","article-title":"Leg length discrepancy after total hip arthroplasty: A review of literature","volume":"6","author":"Desai","year":"2013","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_31","first-page":"884","article-title":"Dislocation following total hip replacement","volume":"111","author":"Dargel","year":"2014","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"441","DOI":"10.5301\/HIP.2011.8575","article-title":"Influence of leg length discrepancy on clinical results after total hip arthroplasty\u2014A prospective clinical trial","volume":"21","author":"Plaass","year":"2011","journal-title":"Hip Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1302\/0301-620X.87B2.14878","article-title":"The importance of leg length discrepancy after total hip arthroplasty","volume":"87","author":"Konyves","year":"2005","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"217","DOI":"10.2106\/00004623-197860020-00014","article-title":"Dislocations after total hip-replacement arthroplasties","volume":"60","author":"Lewinnek","year":"1978","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/j.injury.2021.09.026","article-title":"The value of megaprostheses in non-oncological fractures in elderly patients: A short-term results","volume":"53","author":"Vitiello","year":"2022","journal-title":"Injury"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1007\/s11999-010-1522-2","article-title":"Quality of life following proximal femoral replacement using a modular system in revision THA","volume":"469","author":"Masri","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1589\/jpts.36.81","article-title":"Effect of heel lift insertion on gait function in a patient with total hip arthroplasty with patient-perceived leg length difference: A case report","volume":"36","author":"Shiwa","year":"2024","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s43465-023-01092-1","article-title":"Proximal Femur Megaprostheses in Orthopedic Oncology: Evaluation of a Standardized Post-operative Rehabilitation Protocol","volume":"58","author":"Andreani","year":"2024","journal-title":"Indian J. Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1080\/10255842.2012.761693","article-title":"Sensitivity analysis of a cemented hip stem to implant position and cement mantle thickness","volume":"17","author":"Shi","year":"2014","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Vendittoli, P.A., Martinov, S., Morcos, M.W., Sivaloganathan, S., and Blakeney, W.G. (2022). Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts. J. Clin. Med., 11.","DOI":"10.3390\/jcm11071918"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1530\/EOR-23-0066","article-title":"3D printing for patient-specific implants in musculoskeletal oncology","volume":"8","author":"Kotrych","year":"2023","journal-title":"EFORT Open Rev."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Dragosloveanu, S., Petre, M.-A., Gherghe, M.E., Nedelea, D.-G., Scheau, C., and Cergan, R. (2023). Overall Accuracy of Radiological Digital Planning for Total Hip Arthroplasty in a Specialized Orthopaedics Hospital. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134503"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Timofticiuc, I.-A., Dragosloveanu, S., Caruntu, A., Scheau, A.-E., Badarau, I.A., Garofil, N.D., Didilescu, A.C., Caruntu, C., and Scheau, C. (2024). 3D Bioprinting in Limb Salvage Surgery. J. Funct. Biomater., 15.","DOI":"10.3390\/jfb15120383"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Hu, X., Chen, Y., Cai, W., Cheng, M., Yan, W., and Huang, W. (2022). Computer-Aided Design and 3D Printing of Hemipelvic Endoprosthesis for Personalized Limb-Salvage Reconstruction after Periacetabular Tumor Resection. Bioengineering, 9.","DOI":"10.3390\/bioengineering9080400"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Periferakis, A., Periferakis, A.-T., Troumpata, L., Dragosloveanu, S., Timofticiuc, I.-A., Georgatos-Garcia, S., Scheau, A.-E., Periferakis, K., Caruntu, A., and Badarau, I.A. (2024). Use of Biomaterials in 3D Printing as a Solution to Microbial Infections in Arthroplasty and Osseous Reconstruction. Biomimetics, 9.","DOI":"10.3390\/biomimetics9030154"},{"key":"ref_46","first-page":"57","article-title":"3D-printed patient-specific applications in orthopedics","volume":"8","author":"Wong","year":"2016","journal-title":"Orthop. Res. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Timofticiuc, I.-A., C\u0103linescu, O., Iftime, A., Dragosloveanu, S., Caruntu, A., Scheau, A.-E., Badarau, I.A., Didilescu, A.C., Caruntu, C., and Scheau, C. (2024). Biomaterials Adapted to Vat Photopolymerization in 3D Printing: Characteristics and Medical Applications. J. Funct. Biomater., 15.","DOI":"10.3390\/jfb15120383"},{"key":"ref_48","first-page":"94","article-title":"3D printing metal implants in orthopedic surgery: Methods, applications and future prospects","volume":"42","author":"Meng","year":"2023","journal-title":"J. Orthop. Transl."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Honigmann, P., Sharma, N., Okolo, B., Popp, U., Msallem, B., and Thieringer, F.M. (2018). Patient-Specific Surgical Implants Made of 3D Printed PEEK: Material, Technology, and Scope of Surgical Application. BioMed Res. Int., 2018.","DOI":"10.1155\/2018\/4520636"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1159\/000519599","article-title":"Combination of Reverse Shoulder Prosthesis, Elbow Prosthesis, and Polyetheretherketone: A Modified Total Humeral Replacement for Osteosarcoma Humerus Treatment","volume":"15","author":"Tran","year":"2022","journal-title":"Case Rep. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"731","DOI":"10.3892\/etm.2021.10163","article-title":"Preclinical study analysis of massive magnesium alloy graft for calcaneal fractures","volume":"22","author":"Dragosloveanu","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Jian, S.Y., Lin, C.F., Tsai, T.L., Wang, P.H., Chen, C.H., Lin, S.Y., and Tseng, C.C. (2023). In Vivo Degradation Behavior of Magnesium Alloy for Bone Implants with Improving Biological Activity, Mechanical Properties, and Corrosion Resistance. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24021602"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3435","DOI":"10.1021\/acsbiomaterials.2c01097","article-title":"Biomimetic Porous Magnesium Alloy Scaffolds Promote the Repair of Osteoporotic Bone Defects in Rats through Activating the Wnt\/\u03b2-Catenin Signaling Pathway","volume":"9","author":"Zhu","year":"2023","journal-title":"ACS Biomater. Sci. Eng."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/1120700018811070","article-title":"The use of silver coating in hip megaprostheses: A systematic review","volume":"29","author":"Wyatt","year":"2019","journal-title":"Hip Int."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Schulze, M., Nonhoff, M., Hasselmann, J., Fobker, M., Niemann, S., Theil, C., Gosheger, G., and Puetzler, J. (2023). Shock Wave-Activated Silver-Loaded Biopolymer Implant Coating Eliminates Staphylococcus epidermidis on the Surface and in the Surrounding of Implants. Pharmaceutics, 15.","DOI":"10.3390\/pharmaceutics15122670"},{"key":"ref_56","first-page":"439","article-title":"The Performances of Conventional Titanium and Silver-Coated Megaprostheses in Non-oncological and Post-oncological Patients: An Analysis of Infection Failures in 142 Patients","volume":"10","author":"Sacchetti","year":"2022","journal-title":"Arch. Bone Jt. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1302\/0301-620X.106B4.BJJ-2023-1045.R1","article-title":"A prospective randomized controlled trial comparing CT-based planning with conventional total hip arthroplasty versus robotic arm-assisted total hip arthroplasty","volume":"106-b","author":"Fontalis","year":"2024","journal-title":"Bone Jt. J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1111\/os.13334","article-title":"Total Hip Arthroplasty with Robotic Arm Assistance for Precise Cup Positioning: A Case-Control Study","volume":"14","author":"Guo","year":"2022","journal-title":"Orthop. Surg."}],"container-title":["Symmetry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-8994\/17\/3\/322\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:39:18Z","timestamp":1760027958000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-8994\/17\/3\/322"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,21]]},"references-count":58,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["sym17030322"],"URL":"https:\/\/doi.org\/10.3390\/sym17030322","relation":{},"ISSN":["2073-8994"],"issn-type":[{"value":"2073-8994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,21]]}}}