Neupane G, Madhusudhan R, Shrestha A, Vaishya R
Department of Orthopaedics, Chitwan Medical College, Chitwan, Nepal.
Glan Clwyd Hospital, Wales, LL185UJ UK.
Indian J Orthop. 2020 May 29;54(6):784-794. doi: 10.1007/s43465-020-00146-y. eCollection 2020 Nov.
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.
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.
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.
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.
关于大直径股骨头（LDH）在翻修全髋关节置换术（THA）中的应用，已有大量文献可供参考，但在初次非复杂性THA方面却较为缺乏。本系统评价旨在综合有关初次THA中使用LDH的数据，并分析相关并发症（脱位、体积磨损、植入物生存率和功能评分），以及报告的对活动范围（ROM）、患者报告结局和撞击率/腹股沟疼痛的影响。
采用PRISMA标准进行系统评价，在PubMed数据库中进行广泛检索，并进行线下检索，以查找2008年至2018年间以英文发表的文献。收集了提供不同承重表面上使用大直径股骨头（LDH，36毫米或更大）数据的文章。这包括不同国家强大的国家关节登记处。采用叙述性方法进行数据综合。
共有23篇论文符合我们的纳入标准，包括六个国家关节登记处。观察到LDH的脱位率显著较低，根据Kaplan-Meier生存率计算，植入物生存率极佳（五年时>90%）。除了微创手术（MIS）外，只要仔细修复，手术入路不会增加任何脱位风险。任何功能评分均无显著改善，ROM也未改善。
32 - 36毫米的LDH目前常用于初次THA，并被公认为一种常用尺寸。超过38毫米后，大头尺寸的有益效果就会消失。因此，与过去支持28毫米的文献相反，LDH THA最受欢迎的尺寸是36毫米。
