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Head size in primary total hip arthroplasty

Journal article
Authors Georgios Tsikandylakis
Maziar Mohaddes
Peter Cnudde
A. Eskelinen
Johan Kärrholm
Ola Rolfson
Published in Efort Open Reviews
Volume 3
Issue 5
Pages 225-231
ISSN 2058-5241
Publication year 2018
Published at Institute of Clinical Sciences, Department of Orthopaedics
Pages 225-231
Language en
Keywords head size, large bearing, dislocation, hip arthroplasty, revision, randomized controlled-trial, cross-linked polyethylene, diameter femoral, heads, surg res 2015/101s25-9, local tissue-reactions, metal-on-polyethylene, dual-mobility cup, trunnion corrosion, neck, taper, risk, Orthopedics
Subject categories Orthopedics


The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries. The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship. We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA. We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used. The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm. Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE). Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones. We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer.

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