Clinical Orthopaedics and Related Research®

, Volume 469, Issue 6, pp 1547–1553

Do Large Heads Enhance Stability and Restore Native Anatomy in Primary Total Hip Arthroplasty?

  • Adolph V. LombardiJr.
  • Michael D. Skeels
  • Keith R. Berend
  • Joanne B. Adams
  • Orlando J. Franchi
Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty

DOI: 10.1007/s11999-010-1605-0

Cite this article as:
Lombardi, A.V., Skeels, M.D., Berend, K.R. et al. Clin Orthop Relat Res (2011) 469: 1547. doi:10.1007/s11999-010-1605-0



Dislocation remains a serious complication in hip arthroplasty. Resurfacing proponents tout anatomic femoral head restoration as an advantage over total hip arthroplasty. However, advances in bearings have expanded prosthetic head options from traditional sizes of 22, 26, 28, and 32 mm to diameters as large as 60 mm. Large heads reportedly enhance stability owing to increased range of motion before impingement and increased jump distance to subluxation. Available larger diameter material combinations include metal- or ceramic-on-highly crosslinked polyethylene and metal-on-metal, each with distinct advantages and disadvantages.


We sought to determine (1) if using larger diameter heads has lowered our dislocation rate; and (2) how closely an anatomic metal-on-metal bearing with diameters to 60 mm replicates native femoral head size.


We retrospectively reviewed 2020 primary arthroplasties performed with large heads (≥ 36 mm) in 1748 patients and noted dislocation incidence. In a prospective subset of 89 cases using anatomic heads, native femoral head diameter was measured intraoperatively with calipers by an independent observer and later compared with implanted size.


One dislocation has occurred in 2020 hips for an incidence of 0.05%. The prosthetic head averaged 0.7 mm larger than the native head with 68 of 89 (76%) reconstructed to within ± 2 mm of native size.


Larger diameter heads have contributed to lower dislocation rates and large-diameter metal-on-metal articulation can provide close anatomic restoration in primary THA.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Adolph V. LombardiJr.
    • 1
    • 2
    • 3
  • Michael D. Skeels
    • 4
  • Keith R. Berend
    • 3
    • 5
    • 6
  • Joanne B. Adams
    • 5
  • Orlando J. Franchi
    • 7
  1. 1.Joint Implant Surgeons, IncNew AlbanyUSA
  2. 2.Department of Orthopaedics and Department of Biomedical EngineeringThe Ohio State UniversityColumbusUSA
  3. 3.Mount Carmel Health SystemNew AlbanyUSA
  4. 4.Albert Einstein College of MedicinePhysical Medicine and Rehabilitation ResidencyBronxUSA
  5. 5.Joint Implant Surgeons, IncNew AlbanyUSA
  6. 6.Department of OrthopaedicsThe Ohio State UniversityColumbusUSA
  7. 7.Clinica Santa SofiaCaracasVenezuela

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