Large Diameter Head in Primary Total Hip Arthroplasty: A Systematic Review
G Neupane1, R Madhusudhan1,2, A Shrestha1
1Department of Orthopaedics, Chitwan Medical College, Chitwan, Nepal.
Indian Journal of Orthopaedics
|November 2, 2020
Summary
Large Diameter Heads (LDH) in primary Total Hip Arthroplasty (THA) show low dislocation rates and excellent implant survival. The optimal size for LDH THA is 36 mm, with benefits diminishing beyond 38 mm.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Medical Device Engineering
Background:
- Limited literature exists on Large Diameter Heads (LDH) for primary Total Hip Arthroplasty (THA), contrasting with extensive data for revision THA.
- This review addresses the gap by synthesizing evidence on LDH in primary THA.
Purpose of the Study:
- To systematically review the use of Large Diameter Heads (LDH) in primary Total Hip Arthroplasty (THA).
- To analyze complications such as dislocation, wear, and implant survivorship.
- To evaluate effects on range of motion (ROM), patient-reported outcomes, and impingement.
Main Methods:
- A PRISMA-compliant systematic review was conducted.
- Searches included PubMed and offline sources (2008-2018) for studies on LDH (≥36 mm) in THA.
- Data synthesis employed a narrative approach, incorporating national joint registries.
Main Results:
- Twenty-three papers, including six national registries, met inclusion criteria.
- LDH demonstrated significantly low dislocation rates and excellent implant survivorship (>90% at 5 years).
- No significant improvements were noted in functional scores or range of motion (ROM).
Conclusions:
- Large Diameter Heads (LDH) of 32-36 mm are widely adopted in primary THA.
- The benefits of larger head sizes plateau beyond 38 mm.
- The 36 mm LDH is the preferred size for primary THA, superseding older recommendations for 28 mm heads.
