Ideal Femoral Head Size in Total Hip Arthroplasty Balances Stability and Volumetric Wear
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Over the last several years, a trend towards increasing femoral head size in total hip arthroplasty to improve stability and impingement free range of motion has been observed.
The specific questions we sought to answer in our review were: (1) What are the potential advantages and disadvantages of metal-on-metal, ceramic-on-ceramic, and metal-on-polyethylene bearings? (2) What is effect that femoral head size has on joint kinematics? (3) What is the effect that large femoral heads have on bearing surface wear?
A PubMed search and a review of 2012 Orthopaedic Research Society abstracts was performed and articles were chosen that directly answered components of the specific aims and that reported outcomes with contemporary implant designs or materials.
A review of the literature suggests that increasing femoral head size decreases the risk of postoperative dislocation and improves impingement free range of motion; however, volumetric wear increases with large femoral heads on polyethylene and increases corrosion of the stem in large metal-on-metal modular total hip arthroplasty (THA); however, the risk of potentially developing osteolysis or adverse reactions to metal debris respectively is still unknown. Further, the effect of large femoral heads with ceramic-on-ceramic THA is unclear, due to limited availability and published data.
Surgeons must balance the benefits of larger head size with the increased risk of volumetric wear when determining the appropriate head size for a given patient.
- Ali Khan MA, Brakenbury PH, Reynolds IS. Dislocation following total hip replacement. J Bone Joint Surg [Br] 1981;63-B:214–18.
- Amlie E, Høvik Ø, Reikerås O. Dislocation after total hip arthroplasty with 28 and 32 mm femoral head. J Orthop Traumatol 2010;11:111–15. CrossRef
- Amstutz HC, Lodwig RM, Schurman DJ, Hodgson AG. Range of motion studies for total hip replacements: a comparative study with a new experimental apparatus. Clin Orthop Rel Res. 1975;111:124–30. CrossRef
- Bartel DL, Bicknell VL, Wright TM. The effect of conformity, thickness, and material on stresses in ultra-high molecular components for total joint replacement. J Bone Joint Surg Am. 1986;68(7):1041–51.
- Bartz RL, Noble PC, Kadakia NR, Tullos HS. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg [Am]. 2000;82-A:1300–7.
- Beaulé PE, Schmalzried TP, Udomkiat P, Amstutz HC. Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement. J Bone Joint Surg [Am] 2002;84-A:256–63.
- Bolland BJ, Culliford DJ, Langton DJ, Millington JP, Arden NK, Latham JM. High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. J Bone Joint Surg Br. 2011 May;93(5):608–15. CrossRef
- Bystrom S, Espehaug B, Furnes O, Havelin L. Femoral head size is a risk factor for total hip luxation: a study of 42,987 primary hip arthroplasties from the Norweigian Arthroplasty Register. Acta Orthop Scan 2003; 74(5):514–24. CrossRef
- Chandler DR, Glousman R, Hull D, et al. Prosthetic hip range of motion and impingement: the effects of head and neck geometry. Clin Orthop Rel Res. 1982;166:284–91.
- Clarke IC, Manley MT: Implant Wear Symposium 2007 Engineering Work Group. How do alternative bearing surfaces influence wear behavior? J Am Acad Orthop Surg. 2008;16 Suppl 1:S86–93.
- Cobb JP, Davda K, Ahmad A, Harris SJ, Masjedi M, Hart AJ. Why large-head metal-on-metal hip replacements are painful: the anatomical basis of psoas impingement on the femoral head-neck junction. J Bone Joint Surg Br. 2011 Jul;93(7):881-5. CrossRef
- Cuckler JM, Moore KD, Lombardi AV Jr, McPherson E, Emerson R. Large versus small femoral heads in metal-on-metal total hip arthroplasty. J Arthroplasty 2004;19(Suppl 3):41–4. CrossRef
- Dorlot JM, Christel P, Meunier A. Wear analysis of retrieved alumina heads and sockets of hip prostheses. J Biomed Mater Res. 1989;23:299–310. CrossRef
- Dowd JE, Sychterz CJ, Young AM, et al. Characterization of long-term femoral head penetration rates. Association with and prediction of osteolysis. J Bone Joint Surg Am. 2000;82-A:1102.
- Dumbleton JH, Manley MT, Edidin AA. A literature review of the association between wear rate and osteolysis in total hip arthroplasty. J Arthroplasty. 2002;17(5):649–61. CrossRef
- Dyrkacz RMR, Turgeon T, Ojo O, Brandt JM, Wyss U. Head size affects corrosion behavior in artificial hip joints. Transactions of the 2012 Orthopaedic Research Society.
- Evans P, Lipman J, Rajadhyaksha A, Westrich G. Evaluating the effect of head size and implant design on range of motion in total hip arthroplasty utilizing computerized virtual surgery. Unpublished data from Hospital for Special Surgery.
- Fritsch EW, Gleitz M. Ceramic femoral head fractures in total hip arthoplasty. Clin Orthop Rel Res. 1996;328:129. CrossRef
- Glyn-Jones S, Pandit H, Kwon YM, Doll H, Gill HS. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg [Br] 2009;91(12):1566–1574.
- He RX, Yan SG, Wu LD, Wang XH, Dai XS. Position of the prosthesis and the incidence of dislocation following total hip replacement. Chin Med J (Engl) 2007;120:1140–4.
- Hamilton WG, McAuley JP, Dennis DA, Murphy JA, Blumenfeld TJ, Politi J. THA with Delta Ceramic on Ceramic. Clin Orthop Rel Res. 2010;468:358-366. CrossRef
- Hammerberg EM, Wan Z, Dastane M, Dorr LD. Wear and range of motion of different femoral head sizes. J Arthroplasty. 2010;25(6):839–43. CrossRef
- Hummel MT, Malkani AL, Yakkanti MR, Baker DL. Decreased dislocation after revision total hip arthroplasty using larger femoral head size and posterior capsular repair. J Arthroplasty 2009;24(Suppl):73–6. CrossRef
- Jameson SS, Lees D, James P, Serrano-Pedraza I, Partington PF, Muller SD, Meek RM, Reed MR. Lower rates of dislocation with increased femoral head size after primary total hip replacement: a five-year analysis of NHS patients in England. J Bone Joint Surg [Br]. 2011;93(7):876–80. CrossRef
- Johnston RC, Smidt GL. Hip motion measurements for selected activities of daily living. Clin Orthop Rel Res. 1970;72:205–15.
- Kelley SS, Lachiewicz PF, Hickman JM, Paterno SM. Relationship of femoral head and acetabular size to the prevalence of dislocation. Clin Orthop Rel Res. 1998;355:163–70. CrossRef
- Kurtz SM, Gawel HA, Patel JD. History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Rel Res. 2011;469(8):2262–77. CrossRef
- Lachiewicz PF, Heckman DS, Soileau ES, Mangla J, Martell JM. Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years. Clin Orthop Rel Res. 2009;467(12):3290–6. CrossRef
- Livingston BJ, Chmell MJ, Spector M, Poss R: Complications of total hip arthroplasty associated with the use of an acetabular component with a Hylamer liner. J Bone Joint Surg Am. 1997;79:1529.
- Lombardi AV Jr, Skeels MD, Berend KR, Adams JB, Franchi OJ. Do large heads enhance stability and restore native anatomy in primary total hip arthroplasty? Clin Orthop Relat Res. 2011;469(6):1547–53. CrossRef
- Muratoglu OK, Bragdon CR, O’Connor D, et al. Larger diameter femoral heads used in conjunction with a highly crosslinked ultra-high molecular weight polyethylene: a new concept. J Arthroplasty. 2001;16:24. CrossRef
- Nakahara I, Nakamura N, Takao M, Sakai T, Nishii T, Sugano N. Eight-year wear analysis in longevity highly cross-linked polyethylene liners comparing 26- and 32-mm heads. Arch Orthop Trauma Surg. 2011;131(12):1731–7. CrossRef
- Sayeed SA, Mont MA, Costa CR, Johnson AJ, Naziri Q, Bonutti PM, Delanois RE. Early outcomes of sequentially cross-linked thin polyethylene liners with large diameter femoral heads in total hip arthroplasty. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S90–4.
- Sikes CV, Lai LP, Schreiber M, Mont MA, Jinnah RH, Seyler TM. Instability after total hip arthroplasty: treatment with large femoral heads vs constrained liners. J Arthroplasty. 2008;23(7 suppl):59–63. CrossRef
- Sochart D. Relationship of acetabular wear to osteolysis around total hip components inserted with and without cement. Clin Orthop Rel Res. 1999;363:135.
- Smith TM, Berend KR, Lombardi AV Jr, Emerson RH, Mallory TH. Metal-on-metal total hip arthoplasty with large heads may prevent early dislocation. Clin Orthop Relat Res. 2005;441:137–142. CrossRef
- Stuchin SA. Anatomic diameter femoral heads in total hip arthroplasty: a preliminary report. J Bone Joint Surg Am. 2008;90 Suppl 3:52–6. CrossRef
- van Stralen GM, Struben PJ, van Loon CJ. The incidence of dislocation after primary total hip arthroplasty using posterior approach with posterior soft-tissue repair. Arch Orthop Trauma Surg 2003;123:219–22.
- Wellman G. Ceramic femoral head retrieval data. Clin Orthop Rel Res. 2000;379:22. CrossRef
- Ideal Femoral Head Size in Total Hip Arthroplasty Balances Stability and Volumetric Wear
HSS Journal ®
Volume 8, Issue 3 , pp 270-274
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- femoral head size
- total hip arthroplasty
- volumetric wear
- large femoral heads