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Do Large Heads Enhance Stability and Restore Native Anatomy in Primary Total Hip Arthroplasty?

  • Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Dislocation remains a serious complication in hip arthroplasty. Resurfacing proponents tout anatomic femoral head restoration as an advantage over total hip arthroplasty. However, advances in bearings have expanded prosthetic head options from traditional sizes of 22, 26, 28, and 32 mm to diameters as large as 60 mm. Large heads reportedly enhance stability owing to increased range of motion before impingement and increased jump distance to subluxation. Available larger diameter material combinations include metal- or ceramic-on-highly crosslinked polyethylene and metal-on-metal, each with distinct advantages and disadvantages.

Questions/purposes

We sought to determine (1) if using larger diameter heads has lowered our dislocation rate; and (2) how closely an anatomic metal-on-metal bearing with diameters to 60 mm replicates native femoral head size.

Methods

We retrospectively reviewed 2020 primary arthroplasties performed with large heads (≥ 36 mm) in 1748 patients and noted dislocation incidence. In a prospective subset of 89 cases using anatomic heads, native femoral head diameter was measured intraoperatively with calipers by an independent observer and later compared with implanted size.

Results

One dislocation has occurred in 2020 hips for an incidence of 0.05%. The prosthetic head averaged 0.7 mm larger than the native head with 68 of 89 (76%) reconstructed to within ± 2 mm of native size.

Conclusions

Larger diameter heads have contributed to lower dislocation rates and large-diameter metal-on-metal articulation can provide close anatomic restoration in primary THA.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgment

We thank Thomas H. Mallory, MD, FACS, for his inspiration and mentorship as well as his contribution of cases in our previous study on dislocation in primary THA.

Author information

Authors and Affiliations

  1. Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH, 43054, USA

    Adolph V. Lombardi Jr. MD, FACS

  2. Department of Orthopaedics and Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA

    Adolph V. Lombardi Jr. MD, FACS

  3. Mount Carmel Health System, New Albany, OH, USA

    Adolph V. Lombardi Jr. MD, FACS & Keith R. Berend MD

  4. Albert Einstein College of Medicine, Physical Medicine and Rehabilitation Residency, Bronx, NY, USA

    Michael D. Skeels DO

  5. Joint Implant Surgeons, Inc, New Albany, OH, USA

    Keith R. Berend MD & Joanne B. Adams BFA

  6. Department of Orthopaedics, The Ohio State University, Columbus, OH, USA

    Keith R. Berend MD

  7. Clinica Santa Sofia, Caracas, Venezuela

    Orlando J. Franchi MD

Authors
  1. Adolph V. Lombardi Jr. MD, FACS
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  2. Michael D. Skeels DO
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  3. Keith R. Berend MD
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  4. Joanne B. Adams BFA
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  5. Orlando J. Franchi MD
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Corresponding author

Correspondence to Adolph V. Lombardi Jr. MD, FACS.

Additional information

One or more of the authors (AVL, KRB) receive royalties and institutional research support from and have consulting agreements with Biomet, Inc (Warsaw, IN). One author (KRB) has consulting agreements with Synvasive Technology, Inc (El Dorado Hills, CA) and Salient Surgical Technologies (Portsmouth, NH) and owns stock in Angiotech Pharmaceuticals, Inc (Vancouver, BC, Canada). One author (AVL) receives royalties from Innomed, Inc (Savannah, GA).

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Joint Implant Surgeons, Inc, New Albany, OH, USA.

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Lombardi, A.V., Skeels, M.D., Berend, K.R. et al. Do Large Heads Enhance Stability and Restore Native Anatomy in Primary Total Hip Arthroplasty?. Clin Orthop Relat Res 469, 1547–1553 (2011). https://doi.org/10.1007/s11999-010-1605-0

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  • DOI: https://doi.org/10.1007/s11999-010-1605-0

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