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Ideal Femoral Head Size in Total Hip Arthroplasty Balances Stability and Volumetric Wear

  • Current Topics Concerning Joint Preservation and Minimally Invasive Surgery of the Hip
  • Published:
HSS Journal ®

Abstract

Background

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.

Purpose

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?

Methods

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.

Results

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.

Conclusions

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.

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Disclosures

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a significant conflict of interest in connection with the submitted article.

One or more of the authors (DM) has or may receive payments or benefits from a commercial entity (BrainLab, Smith & Nephew, OrthAlign) that may be perceived as a potential conflict of interest.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Michael B. Cross MD, Denis Nam MD & David J. Mayman MD

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  1. Michael B. Cross MD
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  2. Denis Nam MD
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  3. David J. Mayman MD
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Correspondence to David J. Mayman MD.

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Cross, M.B., Nam, D. & Mayman, D.J. Ideal Femoral Head Size in Total Hip Arthroplasty Balances Stability and Volumetric Wear. HSS Jrnl 8, 270–274 (2012). https://doi.org/10.1007/s11420-012-9287-7

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  • DOI: https://doi.org/10.1007/s11420-012-9287-7

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