Longitudinal Functional Recovery Following Primary Total Hip Arthroplasty Utilizing a Contemporary Triple-Taper Femoral Stem

Background: Contemporary total hip arthroplasty (THA) increasingly emphasizes accelerated recovery, patient-reported outcomes, and value-based care in addition to implant survivorship alone. However, recovery following THA has historically demonstrated substantial variability influenced by demographic, psychosocial, and socioeconomic factors. The purpose of this study was to characterize longitudinal functional recovery trajectories following primary THA utilizing a contemporary triple-taper femoral stem and identify factors associated with early and clinically meaningful postoperative recovery within a standardized contemporary arthroplasty pathway. Methods: A retrospective review was performed of 1,093 consecutive primary THAs performed between 2022 and 2024 utilizing the Insignia femoral stem through a standardized direct anterior approach and contemporary perioperative recovery pathway. Functional recovery was assessed using the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS Jr) collected preoperatively and longitudinally through one year for the entire cohort and through two years for patients eligible at the time of data lock. Recovery trajectory modeling, variability analyses, patient acceptable symptom state (PASS) achievement, substantial clinical benefit (SCB), and multivariable logistic regression analyses evaluating demographic, psychosocial, socioeconomic, and perioperative variables were performed. Results: Mean HOOS Jr improved from 44.8 ± 7.8 preoperatively to 71.9 ± 9.9 at six weeks, 79.5 ± 8.8 at three months, 86.3 ± 6.9 at one year, and 89.3 ± 6.1 among patients eligible for two-year follow-up (p < 0.001). Longitudinal analyses demonstrated progressive improvement in functional outcomes accompanied by narrowing standard deviation and interquartile ranges over time. Because convergence of scores may partially reflect the bounded nature of the HOOS Jr instrument, these findings should be interpreted alongside the potential influence of ceiling effects. Excellent early functional recovery (HOOS Jr ≥85 at three months) was achieved in 29.3% of patients, while PASS achievement at one year occurred in 85.8% of patients. Minimal clinically important improvement (MCII) and SCB achievement occurred in 95.2% and 100% of patients, respectively. Mental health history, opioid refill utilization, and insurance status demonstrated limited independent influence on longitudinal recovery following multivariable adjustment. Overall complication and reoperation rates remained low. Conclusion: Primary THA performed within a standardized contemporary arthroplasty pathway demonstrated substantial longitudinal functional improvement and high rates of clinically meaningful recovery. Recovery trajectories became progressively less variable over time, although this observation should be interpreted in light of potential ceiling effects inherent to patient-reported outcome measures. These findings provide a descriptive characterization of recovery following contemporary primary THA but do not isolate the independent contribution of implant design, surgical approach, or perioperative pathway to postoperative recovery.