Title

Large diameter femoral heads IS BIGGER ALWAYS BETTER?

Publication Date

2014

Journal Title

Bone Joint J

Abstract

Dislocation remains among the most common complications of, and reasons for, revision of both primary and revision total hip replacements (THR). Hence, there is great interest in maximising stability to prevent this complication. Head size has been recognised to have a strong influence on the risk of dislocation post-operatively. As femoral head size increases, stability is augmented, secondary to an increase in impingement-free range of movement. Larger head sizes also greatly increase the 'jump distance' required for the head to dislocate in an appropriately positioned cup. Level-one studies support the use of larger diameter heads as they decrease the risk of dislocation following primary and revision THR. Highly cross-linked polyethylene has allowed us to increase femoral head size, without a marked increase in wear. However, the thin polyethylene liners necessary to accommodate larger heads may increase the risk of liner fracture and larger heads have also been implicated in causing soft-tissue impingement resulting in groin pain. Larger diameter heads also impart larger forces on the femoral trunnion, which may contribute to corrosion, metal release, and adverse local tissue reactions. Alternative large bearings including large ceramic heads and dual mobility bearings may mitigate some of these risks, and several of these devices have been used with clinical success.

Volume Number

96B

Issue Number

11 Supple A

Pages

23-26

Document Type

Article

EPub Date

2014/11/09

Status

Northwell Researcher

Facility

Northwell Health

Primary Department

Orthopedic Surgery

PMID

25381403

DOI

10.1302/0301-620x.96b11.34342