[What's new in hip arthroplasty: philosophical, technical and practical advances from 2021 to 2025]

After a century of development, hip arthroplasty has evolved into a classic surgical procedure with high recognition worldwide. The volume of hip arthroplasty surgeries has rebounded steadily both domestically and internationally, while relevant technologies are advancing toward personalization, digitalization and intellectualization. Restricted by medical registration systems, regulatory policies and uneven resource distribution, notable disparities in clinical quality and outcomes of hip arthroplasty exist across regions and between different areas. This systemic reviews summarize research advances in hip arthroplasty over the past five years. High-quality clinical trials and consensus guidelines were integrated to guide clinical decision-making. Updates regarding prosthesis safe zone, hip-spine relationship, prosthesis design and enhanced recovery were particularly introduced, and objectively evaluation were presented on surgical approaches, reconstructive techniques and digital technologies. Prospectively priorities of hip arthroplasty were also outlined including: national joint replacement registry, ambulatory surgery guided enhanced recovery pathway, translational research on prosthesis-host interaction, and enabling and expanding of digital technologies. This comprehensive review is beneficial to optimize clinical concepts and standardize practice for hip surgeons, and shed lights on the high-quality and sustainable development of hip arthroplasty in China.