Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts

Abstract

Hip arthroplasty is a common procedure in elective orthopaedic surgery that has excellent outcomes. Hip replacement surgery aims to create a “forgotten” joint, i.e., a pain-free joint akin to a native articulation. To achieve such goals, hip arthroplasty must be personalised. This is achieved by restoring: the centre of rotation of the native hip; leg length equality; femoral offset; femoral orientation; soft tissue tension; joint stability with an unrestricted hip range of motion; and having appropriate stress transfer to the bone. In addition, the whole pathway should provide an uneventful and swift postoperative recovery and lifetime implant survivorship with unrestricted activities. At our institution, the preferred option is a personalized total hip arthroplasty (THA) with a large diameter head (LDH) using either monobloc or dual-mobility configuration for the acetabular component. LDH THA offers an impingement-free range of motion and a reduced risk of dislocation. The larger head-neck offset allows for a supraphysiologic range of motion (ROM). This can compensate for a patient’s abnormal spinopelvic mobility and surgical imprecision. Additionally, LDH bearing with a small clearance exerts a high suction force, which provides greater hip micro-stability. With appropriate biomechanical reconstruction, LDH THA can restore normal gait parameters. This results in unrestricted activities and higher patient satisfaction scores. We use LDH ceramic on ceramic for our patients with a life expectancy of more than 20 years and use LDH dual mobility bearings for all others.

Why personalized surgery is the future of hip and knee arthroplasty: a statement from the Personalized Arthroplasty Society

“…Applying the recommendations for a functional implant alignment requires sophisticated preoperative 3D imaging techniques and intraoperative precision tools (precise acetabular component orientation). On the other hand, large diameter head (LDH), including dual mobility, is a much simpler solution ( 46 ). The supraphysiologic ROM offered by the large head–neck offset can compensate for patients’ abnormal spinopelvic mobility and surgeons’ imprecision.…”

Computational Contact Pressure Prediction of CoCrMo, SS 316L and Ti6Al4V Femoral Head against UHMWPE Acetabular Cup under Gait Cycle

“…Unfortunately, the hip joint geometry of Asian people is different from other regions. In Europe, the femoral head tends to use a 32 mm diameter [ 35 ]. Europeans have a relatively larger size of hip joints than Asians.…”

Evaluating the Mechanical and Tribological Properties of 3D Printed Polylactic-Acid (PLA) Green-Composite for Artificial Implant: Hip Joint Case Study

“…To support and help the elderly in such cases, some researchers tried to design exoskeletons that can help them in daily work [ 1 ]. However, orthopedic doctors work on replacing deteriorated joints and performing restoration operations for some bony regions [ 2 ]. In such surgeries, there are two main problems; first, the design complexity of such parts, which is reflected in the difficulty of the production process using available materials in the market like ceramics, metals, and polymers [ 3 ].…”