Large Diameter Head in Primary Total Hip Arthroplasty: A Systematic Review

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: Adverse effect; Bearing surfaces; Dislocation; Primary; Total hip arthroplasty.

Fig. 1

PRISMA 2009 four phase flow diagram (from https://www.prisma-statement.org)