Large Diameter Head in Primary Total Hip Arthroplasty: A Systematic Review
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REVIEW ARTICLE
Large Diameter Head in Primary Total Hip Arthroplasty: A Systematic Review G. Neupane1 · R. Madhusudhan1,2 · A. Shrestha1 · R. Vaishya1,3 Received: 2 April 2020 / Accepted: 18 May 2020 / Published online: 29 May 2020 © Indian Orthopaedics Association 2020
Abstract Introduction The literature around use of Large Diameter Heads (LDH) is abundantly available for revision Total Hip Arthroplasty (THA) but is lacking for primary uncomplicated THA. This systematic review was undertaken to synthesize data around primary THA involving LDH and analyze the associated complications (dislocation, volumetric wear, implant survivorship and functional score) along with reported effects on range of motion (ROM), patient reported outcomes and impingement rate/groin pain. Methods A PRISMA compliant systematic review was done using extensive search in PubMed database, along with offline search looking for the literature published in English language between 2008 and 2018. The articles providing data on the use of large diameter heads (LDH) (36 mm or larger) on various bearing surfaces were collected. This included robust national joint registries of different countries. Narrative approach to data synthesis was used. Results A total of 23 papers met our inclusion criteria, including six national joint registries. It was observed that LDH had significantly low dislocation rates, excellent implant survival rate as per Kaplan–Meier survivorship (> 90% at five years). Surgical approaches, except Minimally Invasive Surgery (MIS), did not increase any risk of dislocation as long as it was meticulously repaired. There was no significant improvement in any functional scores or improved ROM. Conclusions LDH of 32–36 mm are now commonly used in primary THA and is accepted as a popular size. The beneficial effects of a large head size are negated beyond 38 mm. The most favored size for LDH THA, therefore, is 36 mm contrary to the older literature favoring 28 mm. Keywords Total hip arthroplasty · Primary · Adverse effect · Dislocation · Bearing surfaces
Introduction Total hip arthroplasty (THA) is one of the most common and widely performed operations throughout the world which aims to relieve pain, restore function and mobility and improve overall quality of life [1]. It is also regarded as a highly successful and reproducible procedure with cost-effective results [2] and with minimal associated complications.
* G. Neupane [email protected] 1
Department of Orthopaedics, Chitwan Medical College, Chitwan, Nepal
2
Glan Clwyd Hospital, Wales LL185UJ, UK
3
Indraprastha Apollo Hospital, New Delhi, India
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Large Diameter Head (LDH) in THA is reported to have improved range of motion (ROM), greater jump distance, decreased impingement and resultant increased stability [3–5] and the drawbacks being increased rate of wear leading to implant loosening and taper corrosion (trunnionosis), generation of wear particles leading to problems like metallosis and ALVAL (Aseptic Lymphocyte-dominan
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