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The alternatives for revision surgery on a dislocating hip such as cup revision, stem revision, or changing to a larger articulation is often not feasible because of comorbidities.
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The low wear rates reported for XLPE have also encouraged the use of larger articulations, which have been shown to reduce the incidence of dislocation within the first year after THA (Howie et al. 2012).
The wear of 7 different XLPE components was measured, incorporating 3 designs of cemented XLPE acetabular components and 4 designs of XLPE liners of uncemented acetabular components, as detailed in Table 1. 10 of the 12 cohorts received 28-mm articulations, and 2 cohorts involved larger articulations (32-mm and 36-mm).
The pattern with very similar 2 year changes in ROM indicates that the restraints could have limited the initial flexibility of the soft tissue, so once the restrictions were lifted and time had passed, the patients became less aware of the hip and used it more naturally allowing the standard THA group to catch up with the larger articulations.
The knee joint complex is the largest articulation in the human body, with each component playing a specific function.
Triamcinolone acetonide (40 mg/ml) or methylpredinosolone acetate (40 mg/ml) are widely used in North America at a dose ranging from 10 mg or less for small articulations to 40 mg for large articulations.
The lack of restriction allowed for large articulations did not improve the clinical and patient perceived outcomes.
Large articulations increased the mean total range of motion by 13° during the first 6 postoperative months.
The patients with large articulations still reported slightly less discomfort, but the difference was not significant (p = 0.3).
During the first 6 months, we observed a small difference favoring the large articulations, but the larger head size may not have been the cause.
Range of motion was the primary outcome, and we could not demonstrate any advantage of the unrestricted regime allowed for the large articulations.
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