Advances in Total Hip Arthroplasty: A Comprehensive Review of Surgical Techniques, Implant Designs, and Postoperative Outcomes.

Total hip arthroplasty (THA) is a key surgical procedure for the treatment of end-stage hip disease and a primary tool for restoring mobility and quality of life globally. Although the field is evolving rapidly, evidence about advances in THA is sparse and scattered over different surgical techniques, implant designs, and perioperative strategies, making it difficult to interpret at a system level. This review aims to unite and synthesize the current evidence critically to understand the impact of interacting technical and biological factors on durable outcomes. PubMed, Embase, Web of Science, and the Cochrane Library were searched from 2015 to 2025 for an integrative review of the narrative. Randomized trials, comparative observational studies, registry analyses, and high-quality systematic reviews of primary THA were included. The evidence synthesis included the focus on the mechanistic connections between component positioning, fixation biology, bearing performance, and recovery environments with functional durability and implant survivability. Key findings suggest that no single innovation is enough to ensure success, and coordinated optimization of the accuracy of alignment, soft-tissue management, fixation strategy, and improved patient recovery pathways will consistently impact stability, wear characteristics, and patient-reported performance. It is often difficult to distinguish the relevance of methods and endpoints that are not the same. Integrated evaluation helps guide patient-specific treatment decisions, technology selection, and innovation that aligns with value-based care. This review firmly establishes that the engineering approach to viewing THA as a clinical system provides a clearer understanding of advances and direction of future investigations.