Two Year Clinical Outcomes of Total Hip Arthroplasty Are Not Dependent on Femoral Head Composition



Assessment of clinical outcomes and patient quality of life after total hip arthroplasty continues to grow in importance with the focus on how bearing surfaces affect long-term survival, wear, and cost. Further, as quality measures have become incorporated into reimbursement, there is a need to quantify factors which may influence these outcomes. Currently, there is a paucity of literature regarding the effects of the femoral head composition on clinical outcomes or quality of life.


We sought to determine if any difference in quality of life measures could be detected in patients treated with total hip replacement implanted with cobalt-chrome (CoCr) versus ceramic femoral heads at 2-year follow-up.


We compared the hip disability and osteoarthritis outcome score (HOOS) and EuroQOL (EQ5D) scores of a matched set of patients that underwent primary total hip arthroplasty with highly cross-linked polyethylene (HXLPE) and a single implant system consisting of either a metal or a ceramic femoral head.


Clinical outcomes and quality of life improved for both groups after hip replacement surgery. Patients with a ceramic head showed greater improvement than those with a metal head in HOOS pain and EQ5D VAS scores by a statistically significant margin (p = 0.0417 and 0.019, respectively), but the differences between the HOOS and EQ5D VAS scores (3.4 and 0.04, respectively) do not demonstrate a clinically significant difference.


We found that the femoral head composition has no effect on clinical outcomes or patient quality of life at 2 years.

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Conflict of Interest

Michael P. Ast, MD, Stephen Lyman, PhD, Alexandra H. Gorab, BS, Natalie Parkes, BA, John Boles, BS, and Yuo-yu Lee, MS have declared that they have no conflict of interest. Geoffrey H. Westrich, MD reports grants and personal fees from Stryker Orthopedics and Exactech; grants from DJO; committee member of the Knee Society and a board member of the Eastern Orthopedic Association, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Corresponding author

Correspondence to Geoffrey H. Westrich MD.

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Level of Evidence

Therapeutic Study Level III

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Ast, M.P., Lyman, S., Gorab, A.H. et al. Two Year Clinical Outcomes of Total Hip Arthroplasty Are Not Dependent on Femoral Head Composition. HSS Jrnl 11, 130–135 (2015).

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  • femoral head
  • metal
  • ceramic
  • THA
  • arthroplasty
  • clinical outcomes
  • EQ5D
  • quality of life