Hip Pelvis.  2016 Sep;28(3):134-141. 10.5371/hp.2016.28.3.134.

Current Concepts of Using Large Femoral Heads in Total Hip Arthroplasty

• Cho MR
• Choi WK
• Kim JJ

• KMID: 2354544
• DOI: http://doi.org/10.5371/hp.2016.28.3.134

Abstract

Instability and dislocation after total hip arthroplasty are the most common causes of revisions and major complications for failure of inserted prostheses, leading to a reduction in quality of life. Because the use of artificial femoral head sizes smaller than patient's own size is the important cause for dislocation, the use of large femoral head have increased. Femoral head sizes greater than 32 mm offer multiple advantages in physical function and activity levels of patients by improving hip stability, decreasing dislocation rate and increasing range of motion. However, various concerns are encountered including wear debris generation at the trunnion-bore interface and increases in frictional torque and stress over the component-bone interface when using larger head sizes. So, the use of femoral head sizes less than 40 mm is recommended.

Keyword

Large femoral head; Instability; Dislocation; Total hip arthroplasty

MeSH Terms

Arthroplasty, Replacement, Hip*
Dislocations
Friction
Head*
Hip
Humans
Prostheses and Implants
Quality of Life
Range of Motion, Articular
Torque

Figure

• 

  Fig. 1 A larger diameter head (B) has the greater range of motion than smaller one (A) by delaying neck socket impingement.

• 

  Fig. 2 A larger femoral head (B) must be displaced by greater distance than smaller one (A) for complete dislocation.

• 

  Fig. 3 When appropriately seated on the tapered trunnion of the neck, a moment arm exists between the center of rotation of the head and the center of pressure on the trunnion.

Reference

1. Eftekhar NS. Dislocation and instability complicating low friction arthroplasty of the hip joint. Clin Orthop Relat Res. 1976; (121):120–125.

2. McKee GK, Watson-Farrar J. Replacement of arthritic hips by the McKee-Farrar prosthesis. J Bone Joint Surg Br. 1966; 48:245–259.

3. Schmalzried TP, Szuszczewicz ES, Akizuki KH, Petersen TD, Amstutz HC. Factors correlating with long term survival of McKee-Farrar total hip prostheses. Clin Orthop Relat Res. 1996; 329 Suppl. S48–S59.

4. Charnley J. Arthroplasty of the hip. A new operation. Lancet. 1961; 1:1129–1132.

5. Charnley J. Surgery of the hip-joint: present and future developments. Br Med J. 1960; 1:821–826.

6. Charnley J. Low friction arthroplasty of the hip. Berlin, New York: Springer-Verlag;1979. p. 314–319.

7. McCollum DE, Gray WJ. Dislocation after total hip arthroplasty. Causes and prevention. Clin Orthop Relat Res. 1990; (261):159–170.

8. Fender D, Harper WM, Gregg PJ. Outcome of Charnley total hip replacement across a single health region in England: the results at five years from a regional hip register. J Bone Joint Surg Br. 1999; 81:577–581.

9. Jasty M, Goetz DD, Bragdon CR, et al. Wear of polyethylene acetabular components in total hip arthroplasty An analysis of one hundred and twenty-eight components retrieved at autopsy or revision operations. J Bone Joint Surg Am. 1997; 79:349–358.

10. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990; 72:518–528.

11. Kabo JM, Gebhard JS, Loren G, Amstutz HC. In vivo wear of polyethylene acetabular components. J Bone Joint Surg Br. 1993; 75:254–258.

12. Shanbhag AS, Rubash HE. Wear: the basis of particle disease in total hip arthroplasty. Tech Orthop. 1993; 8:269–274.

13. Mai MT, Schmalzried TP, Dorey FJ, Campbell PA, Amstutz HC. The contribution of frictional torque to loosening at the cement-bone interface in Tharies hip replacements. J Bone Joint Surg Am. 1996; 78:505–511.

14. Ali Khan MA, Brakenbury PH, Reynolds IS. Dislocation following total hip replacement. J Bone Joint Surg Br. 1981; 63-B:214–218.

15. Kristiansen B, Jørgensen L, Hölmich P. Dislocation following total hip arthroplasty. Arch Orthop Trauma Surg. 1985; 103:375–377.

16. Ritter MA. Dislocation and subluxation of the total hip replacement. Clin Orthop Relat Res. 1976; (121):92–94.

17. Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982; 64:1295–1306.

18. Barrack RL, Butler RA, Laster DR, Andrews P. Stem design and dislocation after revision total hip arthroplasty: clinical results and computer modeling. J Arthroplasty. 2001; 16:8–12.

19. Morrey BF. Instability after total hip arthroplasty. Orthop Clin North Am. 1992; 23:237–248.

20. Amstutz HC, Lodwig RM, Schurman DJ, Hodgson AG. Range of motion studies for total hip replacements. A comparative study with a new experimental apparatus. Clin Orthop Relat Res. 1975; (111):124–130.

21. Burroughs BR, Hallstrom B, Golladay GJ, Harris WH. Dislocation without impingement. Paper presented at: 31st Annual Hip Course, A New Era in Total Hip Arthroplasty: The Era of the Big Head. 2001 Oct; Cambridge, MA, USA. Cambridge: Havard Medical Schoola;2001.

22. Scifert CF, Noble PC, Brown TD, et al. Experimental and computational simulation of total hip arthroplasty dislocation. Orthop Clin North Am. 2001; 32:553–567. vii

23. Chandler DR, Glousman R, Hull D, et al. Prosthetic hip range of motion and impingement. The effects of head and neck geometry. Clin Orthop Relat Res. 1982; (166):284–291.

24. Pasley BS. Head size vs. capsular repair: which is important? Paper presented at: 31st Annual Hip Course, A New Era in Total Hip Arthroplasty: The Era of the Big Head. 2001 Oct; Cambridge, MA, USA. Cambridge: Havard Medical School;2001.

25. BR H. Advantages of the large head: range of the motion and bone to bone contact. Paper presented at: 31st Annual Hip Course, A New Era in Total Hip Arthroplasty: The Era of the Big Head. 2001 Oct; Cambridge, MA, USA. Cambridge: Havard Medical School;2001.

26. Yamaguchi M, Akisue T, Bauer TW, Hashimoto Y. The spatial location of impingement in total hip arthroplasty. J Arthroplasty. 2000; 15:305–313.

27. Gilbert JL, Buckley CA, Jacobs JJ. In vivo corrosion of modular hip prosthesis components in mixed and similar metal combinations. The effect of crevice, stress, motion, and alloy coupling. J Biomed Mater Res. 1993; 27:1533–1544.

28. Goldberg JR, Gilbert JL. In vitro corrosion testing of modular hip tapers. J Biomed Mater Res B Appl Biomater. 2003; 64:78–93.

29. Cooper HJ, Della Valle CJ, Berger RA, et al. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am. 2012; 94:1655–1661.

30. Botti TP, Gent J, Martell JM, Manning DW. Trunion fracture of a fully porous-coated femoral stem. Case report. J Arthroplasty. 2005; 20:943–945.

31. Elkins JM, Callaghan JJ, Brown TD. Stability and trunnion wear potential in large-diameter metal-on-metal total hips: a finite element analysis. Clin Orthop Relat Res. 2014; 472:529–542.

32. Cooper HJ, Della Valle CJ. Large diameter femoral heads: is bigger always better? Bone Joint J. 2014; 96-B:23–26.

33. Lavernia CJ, Iacobelli DA, Villa JM, Jones K, Gonzalez JL, Jones WK. Trunnion-head stresses in THA: are big heads trouble? J Arthroplasty. 2015; 30:1085–1088.

34. Tan SC, Lau AC, Del Balso C, Howard JL, Lanting BA, Teeter MG. Tribocorrosion: ceramic and oxidized zirconium vs cobalt-chromium heads in total hip arthroplasty. J Arthroplasty. 2016; 31:2064–2071.

35. Bartelt RB, Yuan BJ, Trousdale RT, Sierra RJ. The prevalence of groin pain after metal-on-metal total hip arthroplasty and total hip resurfacing. Clin Orthop Relat Res. 2010; 468:2346–2356.

36. Baumgarten KM, McKenzie MJ. Iliopsoas tendon impingement after total hip arthroplasty with use of a large-diameter femoral head. JBJS Case Connect. 2012; 2:e22.

37. Browne JA, Polga DJ, Sierra RJ, Trousdale RT, Cabanela ME. Failure of larger-diameter metal-on-metal total hip arthroplasty resulting from anterior iliopsoas impingement. J Arthroplasty. 2011; 26:978.e5–978.e8.

38. Varadarajan KM, Duffy M, Zumbrunn T, et al. Next-generation soft-tissue-friendly large-diameter femoral head. Semin Arthroplasty. 2013; 24:211–217.

39. Varadarajan KM, Duffy M, Zumbrunn T, et al. A new anatomically contoured large diameter femoral head to alleviate soft-tissue impingement in hip arthroplasty. Bone Joint J. 2013; 95-B:Suppl 34. 408.

40. Astion DJ, Saluan P, Stulberg BN, Rimnac CM, Li S. The porous-coated anatomic total hip prosthesis: failure of the metal-backed acetabular component. J Bone Joint Surg Am. 1996; 78:755–766.

41. Bartel DL, Bicknell VL, Wright TM. The effect of conformity, thickness, and material on stresses in ultra-high molecular weight components for total joint replacement. J Bone Joint Surg Am. 1986; 68:1041–1051.

42. Berman AT, Avolio A Jr, DelGallo W. Acetabular osteolysis in total hip arthroplasty: prevention and treatment. Orthopedics. 1994; 17:963–965.

43. Lee PC, Shih CH, Chen WJ, Tu YK, Tai CL. Early polyethylene wear and osteolysis in cementless total hip arthroplasty: the influence of femoral head size and polyethylene thickness. J Arthroplasty. 1999; 14:976–981.

44. Muratoglu OK, Bragdon CR, O'Connor DO, Jasty M, Harris WH. A novel method of cross-linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties. Recipient of the 1999 HAP Paul award. J Arthroplasty. 2001; 16:149–160.

45. Muratoglu OK, Bragdon CR, O'Connor DO, et al. Unified wear model for highly crosslinked ultra-high molecular weight polyethylenes (UHMWPE). Biomaterials. 1999; 20:1463–1470.

46. Kurtz SM, Edidin AA, Bartel DL. The role of backside polishing, cup angle, and polyethylene thickness on the contact stresses in metal-backed acetabular components. J Biomech. 1997; 30:639–642.

47. Nam D, Barrack T, Johnson SR, Nunley RM, Barrack RL. Hard-on-hard bearings are associated with increased noise generation in young patients undergoing hip arthroplasty. Clin Orthop Relat Res. 2016; 474:2115–2122.