The Effect of Femoral Head Size on Groin Pain in Total Hip Arthroplasty

Background: Although increased femoral head size reduces the risk of instability in total hip arthroplasty (THA), it may lead to iliopsoas irritation and increased anterior groin pain. The purpose of this study is to compare outcomes between non-modular dual-mobility (NDM) implants and small (<= 32 mm) and large (>= 36 mm) fixed-bearing (FB) constructs. Methods: A retrospective review of all primary total hip arthroplasties from 2011 to 2021 was conducted at a single, urban academic institution. Patients were separated into 3 cohorts: NDM implant <= 32 mm and FB implant >= 36 mm. Demographics and outcomes such as length of stay, dislocation, and anterior groin pain were assessed. Patients were deemed as having groin pain if they received an iliopsoas injection or had extended physical therapy ordered beyond 3 months postoperatively. Results: There were 178 NDM implants, 936 <= 32-mm FB, and 2,454 >= 36-mm FB implants included. Length of stay significantly differed between the groups (48.4 +/- 43.3 vs 63.2 +/- 40.6 vs 57.2 +/- 38.1 hours; P = .001). Although not statistically significant, the >= 36-mm FB cohort had the highest rate of dislocations (0.6% vs 0.7% vs 0.9%; P = .84). Although no patients with an NDM implant received an iliopsoas injection, 9 patients (0.9%) with a <= 32-mm FB implant and 9 patients (0.4%) with a >= 36-mm implant received an injection (P = .06). However, 18 (10.1%) patients with an NDM implant, 304 (32.5%) patients with a <= 32-mm FB implant, and 355 (14.5%) patients with a >= 36-mm FB implant received extended physical therapy 3 months after surgery (P <.001). Conclusion: NDM implants, as well as FB implants with both small and large head sizes are effective at preventing dislocation. NDM implants did not result in an increase in anterior groin pain compared to <= 32-mm and >= 36-mm FB constructs. (C) 2022 Elsevier Inc. All rights reserved.