Large-diameter femoral heads in total hip arthroplasty: an evidence-based review.
Recent advances in the wear characteristics and material properties of highly cross-linked polyethyl-ene and fourth-generation ceramic bearings have led to increasing use of large-diameter (≥ 36 mm) femoral heads in total hip arthroplasty (THA). In this article, we review the current concepts and principles behind use of large-diameter ceramic or cobalt-chromium femoral heads on polyethylene bearings in THA. We specifically review the biomechanics, some of the early concerns about polyethylene wear and rim fractures, recent improvements in material properties of polyethylene and ceramic bearings, dislocation rates, and clinical and functional outcomes of large-diameter heads in THA. Recent literature suggests that the incidence of dislocation has been substantially reduced because of improvements in jump distance and impingement-free range of motion with use of large-diameter heads. Limited evidence suggests excellent short-term and midterm clinical and functional outcomes with these heads.
Samik
S
Banerjee
Robert
R
Pivec
Kimona
K
Issa
Bhaveen H
BH
Kapadia
Harpal S
HS
Khanuja
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD. mmont@lifebridgehealth.org.
Michael A
MA
Mont
D019644:Arthroplasty, Replacement, Hip; D001672:Biocompatible Materials; D001696:Biomechanical Phenomena; D002516:Ceramics; D002857:Chromium; D003035:Cobalt; D005270:Femur Head / Q000503:physiopathology / Q000601:surgery*; D006617:Hip Dislocation / Q000503:physiopathology / Q000517:prevention & control*; D006622:Hip Prosthesis; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000517:prevention & control; D008422:Materials Testing; D020959:Polyethylene; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D012086:Reoperation
D001672:Biocompatible Materials; D002857:Chromium; D003035:Cobalt; D020959:Polyethylene