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

Neupane, Gaurav; Madhusudhan, R; Shrestha, Ashis; Vaishya, Raju

doi:10.1007/s43465-020-00146-y

Cited by 4 publications

(5 citation statements)

References 35 publications

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“… 21 , 48 When excluding revisions for ARMD, our cohort has a 3.2% revision rate, which is, interestingly, within the range of 1% to 5% risk of revision reported in the literature for LDH THA on non-atypical acetabula. 49 In the current cohort, we had a 1.6% deep infection rate, which is slightly higher than our overall historical THA infection rate of 1.4%. 50 This is related to the level of complexity of these cases, as they usually required a longer operating time and more blood loss, and some required femoral-shortening osteotomy and hardware fixation.…”

Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

“…A systematic review of LDH THA on non-atypical acetabula conducted by Neupane and colleagues confirmed that MoM prostheses are associated with the highest revision rate because of ARMD complications. 49 LDH prostheses have been shown to provide better joint stability and lower dislocation rates. 6,7 These characteristics were reflected in this study, in which no hip dislocation was reported.…”

Section: E45mentioning

confidence: 99%

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Total hip arthroplasty with monobloc press-fit acetabular components and large-diameter bearings for atypical acetabula is safe: a consecutive case series of 125 hips with mean follow-up of 9 years

Synnott,

Kiss,

Shahin

et al. 2024

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Background: Large-diameter head (LDH) total hip arthroplasty (THA) with a monobloc acetabular component improves hip stability. However, obtaining initial press-fit stability is quite challenging in atypical acetabula. The purpose of this study was to assess primary and secondary fixation of monobloc cups in atypical acetabula. Methods: In this consecutive case series, the local arthroplasty database was used to retrospectively identify patients with secondary osteoarthritis who underwent primary hip replacement with press-fit only LDH monobloc acetabular components between 2005 and 2018 and who had a minimum of 2 years of follow-up. Radiographic evaluation was performed at last follow-up, and patient-reported outcome measures (PROMs) were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Forgotten Joint Score (FJS), and the Patient’s Joint Perception (PJP) question. Results: One hundred and six LDH THAs and 19 hip resurfacings were included in the study. Preoperative diagnoses included hip dysplasia (36.8%), Legg–Calve–Perthes disease (32.0%), osteoarthritis with acetabular deficiency (17.6%), periacetabular osteotomy (8.0%), arthrodesis (4.0%), and osteopetrosis (1.6%). After a mean follow-up of 9.2 years, no aseptic loosening of the acetabular component was recorded nor observed on radiologic review. There were 13 (10.4%) revisions unrelated to the acetabular component fixation. The mean WOMAC and FJS scores were 9.2 and 80.9, respectively. In response to the PJP question, 49.4% of the patients perceived their hip as natural, 19.1% as an artificial joint with no restriction, 31.5% as an artificial joint with restriction, and none as a non-functional joint. Conclusion: Primary press-fit fixation of monobloc acetabular components with LDH implanted in atypical acetabula led to secondary fixation in all cases with low revision and complication rates and great functional outcomes. With careful surgical technique and experience, systematic use of supplemental screw fixation is not essential in THA with atypical acetabula.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: E45mentioning

confidence: 99%

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Total hip arthroplasty with monobloc press-fit acetabular components and large-diameter bearings for atypical acetabula is safe: a consecutive case series of 125 hips with mean follow-up of 9 years

Synnott,

Kiss,

Shahin

et al. 2024

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“…In the late 1990s, metal-on-metal (MoM) implants with large-diameter heads (LDHs) were introduced [ 2 ]. A LDH MoM (36 mm or larger) has shown to increase implant stability and decrease dislocation risk, but beneficial effects large head size implant are negated beyond a size of 38 mm due to increased volumetric metal wear [ 3 ]. After a promising start, several studies with these second-generation MoM bearings, including LDHs, have shown an increased risk to adverse reactions to metal debris (ARMD) and higher-than-expected revision rates [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term survival analysis of cementless large-diameter head metal-on-metal total hip arthroplasty

Holappa

Kettunen

Miettinen

et al. 2022

Arch Orthop Trauma Surg

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Introduction The aim of this retrospective study was to study the long-term survival and reasons for revisions of a single-type, large-diameter head (LDH) metal-on-metal (MoM) implant. A special study interest was to find the threshold level for revision in terms of adverse reaction to metal debris (ARMD). Materials and Methods In this cohort study, we retrospectively reviewed 234 patients (253 hips) who received 38 mm head size LDH MoM total hip arthroplasties (THAs) between 01 January 2004 and 31 December 2009 at our institution. Patient symptoms, conventional radiographs, magnetic resonance imaging (MRI) findings and whole blood metal ions were studied. Results The median follow-up time was 11.5 years. The Kaplan–Meier cumulative survival estimate of the implant was 89.6% at 10 years and 82.9% at 14.6 years. Overall, 34/253 (13.4%) hips were revised during the follow-up period and of these; 19/34 (55.9%) were revised due to ARMD. The prevalence of ARMD was 12.4% (29/234 patients). Conclusions The survival of the implant was on a moderate level as the 10-year cumulative survival rate was 89.6%. The exact threshold level for ARMD revision cannot be determined due to multiple variables affecting factors in re-operation decision-making.

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“…Surgical techniques and design of the prostheses have been improved since its introduction, in order to optimize clinical outcomes and component survival. A clear example is that various studies demonstrated that larger head size results in a lower risk of dislocation [ 3 – 8 ]. However, dislocation remains a major and relatively frequent complication.…”

Section: Introductionmentioning

confidence: 99%

Did the dislocation risk after primary total hip arthroplasty decrease over time? A meta-analysis across six decades

Erp

Hüsken

Filipe

et al. 2022

Arch Orthop Trauma Surg

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Background While continuous optimization is attempted to decrease the incidence of dislocation after total hip arthroplasty (THA), dislocation remains a major complication. This meta-analysis aims to analyze the evolution of the dislocation risk after primary THA over the decades and to evaluate its potential publication bias. Patients and methods A systematic search was performed according to the PRISMA guidelines for this meta-analysis in the literature published between 1962 and 2020. MEDLINE, Cochrane and Embase databases were searched for studies reporting the dislocation risk and length of follow-up. Studies that reported on revision rates only and did not mention separate dislocations were excluded. All study designs were eligible. Study quality was assessed by existing quality assessment tools adjusted for arthroplasty research. Overall risk and yearly dislocation rates were calculated and related to historical time frame, study design, sample size and length of follow-up. Results In total, 174 studies were included with an overall moderate quality. In total there were 85.209 dislocations reported in 5.030.293 THAs, showing an overall dislocation risk of 1.7%, with a median follow-up of 24 months. The overall dislocation risk classified per decade decreased from 3.7% in 1960–1970 to 0.7% in 2010–2020. The yearly dislocation rate decreased from 1.8 to 0.7% within these same decades. There was no significant correlation between the reported dislocation risk and the duration of follow-up (p = 0.903) or sample size (p = 0.755). The reported dislocation risk was higher in articles with registry data compared to other study designs (p = 0.021). Conclusion The dislocation risk in THA has been decreasing over the past decades to 0.7%. Non-selective registry studies reported a higher dislocation risk compared to studies with selective cohorts and RCTs. This indicates that the actual dislocation risk is higher than often reported and ‘real-world data’ are reflected better in large-scale cohorts and registries.

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

Cited by 4 publications

References 35 publications

Total hip arthroplasty with monobloc press-fit acetabular components and large-diameter bearings for atypical acetabula is safe: a consecutive case series of 125 hips with mean follow-up of 9 years

Total hip arthroplasty with monobloc press-fit acetabular components and large-diameter bearings for atypical acetabula is safe: a consecutive case series of 125 hips with mean follow-up of 9 years

Long-term survival analysis of cementless large-diameter head metal-on-metal total hip arthroplasty

Did the dislocation risk after primary total hip arthroplasty decrease over time? A meta-analysis across six decades

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