Personalized hip joint replacements using a large diameter head

Background: Conventional total hip arthroplasty (THA) aims to restore native joint kinematics, yet complications such as dislocation, implant malpositioning, and restricted range of motion (ROM) persist. Achieving optimal functional outcomes requires precise anatomical restoration and accelerated postoperative rehabilitation to meet increasing patient expectations for activity and joint perception.

Objective: This article examines the clinical application of personalized THA utilizing large diameter head (LDH) bearings—specifically ceramic-on-ceramic (CoC) and dual mobility (DM) designs—integrated with enhanced recovery after surgery (ERAS) protocols.

Key Points: LDH THA, defined by femoral heads exceeding 36 mm, increases jump distance and the head-to-neck ratio, significantly reducing dislocation risk and providing supraphysiological ROM. This configuration compensates for surgical imprecision and variations in spinopelvic mobility. Clinical evidence supports the use of CoC LDH for patients with a life expectancy over 20 years due to superior wear resistance and reduced osteolysis. Conversely, DM LDH is indicated for older or higher-risk populations. LDH bearings also enhance micro-stability via increased suction forces. Implementation of ERAS protocols has been shown to reduce postoperative complications by 50% and facilitate outpatient surgery by decreasing hospital length of stay. While CoC bearings may produce audible noise, it is generally benign and does not correlate with decreased functional scores. Trunnionosis risks are mitigated through the use of ceramic femoral heads.

Conclusion: The integration of LDH bearings with ERAS principles facilitates precise biomechanical reconstruction and rapid functional recovery. This combined approach optimizes implant stability and survivorship, providing a viable pathway toward achieving a forgotten joint in personalized hip reconstruction.