Head size in primary total hip arthroplasty
Georgios Tsikandylakis, Maziar Mohaddes, Peter Cnudde, Antti Eskelinen, Johan Kärrholm, and Ola RolfsonHip
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The use of larger femoral head size in total hip arthroplasty (THA) has increased during the past decade; 32 mm and 36 mm are the most commonly used femoral head sizes, as reported by several arthroplasty registries.
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The use of large femoral heads seems to be a trade-off between increased stability and decreased THA survivorship.
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We reviewed the literature, mainly focussing on the past 5 years, identifying benefits and complications associated with the trend of using larger femoral heads in THA.
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We found that there is no benefit in hip range of movement or hip function when head sizes > 36 mm are used.
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The risk of revision due to dislocation is lower for 36 mm or larger bearings compared with 28 mm or smaller and probably even with 32 mm.
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Volumetric wear and frictional torque are increased in bearings bigger than 32 mm compared with 32 mm or smaller in metal-on-cross-linked polyethylene (MoXLPE) THA, but not in ceramic-on-XLPE (CoXLPE).
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Long-term THA survivorship is improved for 32 mm MoXLPE bearings compared with both larger and smaller ones.
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We recommend a 32 mm femoral head if MoXLPE bearings are used. In hips operated on with larger bearings the use of ceramic heads on XLPE appears to be safer.
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