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    The Advantages – and Disadvantages – of Larger Femoral Heads

    Dr. Bryan Springer shares his thoughts on how increasing the femoral head size affects the risk of dislocation after total hip arthroplasty.

    The risk of dislocation following primary and revision total hip arthroplasty (THA) remains a problem, and it has prompted orthopaedic surgeons to search for solutions to stabilize the hip and reduce the risk.

    One such solution is larger femoral head sizes. Research has shown these larger heads to be directly related to increased stability of the hip following THA, which helps to reduce dislocations. [1-8]

    The tradeoff is thinner polyethylene linings, which may be more prone to fracture. In addition, larger heads can cause groin pain from soft-tissue impingement. [9]

    At ICJR’s Pacific Orthopaedic Congress, we asked Bryan Springer, MD, from OrthoCarolina in Charlotte, North Carolina, to discuss the advantages and disadvantages of larger femoral heads, as well as the role of the bearing surface material in his choice of femoral head size.

    Click the images below to hear his comments.

    Advantages and disadvantages of larger femoral heads

    Bearing surfaces and larger femoral heads

    References

    1. Bartz RL, Noble PC, Kadakia NR, Tullos HS. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg Am. 2000;82:1300-1307.
    2. Berry DJ, von Knoch M, Schleck CD, Harmsen WS. Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am. 2005;87:2456-2463.
    3. Conroy JL, Whitehouse SL, Graves SE, Pratt NL, Ryan P, Crawford RW. Risk factors for revision for early dislocation in total hip arthroplasty. J Arthroplasty. 2008;23:867-872.
    4. Crowninshield RD, Maloney WJ, Wentz DH, Humphrey SM, Blanchard CR. Biomechanics of large femoral heads: what they do and don’t do. Clin Orthop Relat Res. 2004;429:102-107.
    5. Cuckler JM, Moore KD, Lombardi AV, McPherson E, Emerson R. Large versus small femoral heads in metal-on-metal total hip arthroplasty. J Arthroplasty. 2004;19:41-44.
    6. Peters CL, McPherson E, Jackson JD, Ereckson JA. Reduction in early dislocation rate with large-diameter femoral heads in primary total hip arthroplasty. J Arthroplasty. 2007;22:140-144.
    7. Smith TM, Berend KR, Lombardi AV, Emerson RH, Mallory TH. Metal-on metal total hip arthroplasty with large heads may prevent early dislocation. Clin Orthop Relat Res. 2005;441:137-142.
    8. Stuchin SA. Anatomic diameter femoral heads in total hip arthroplasty: a preliminary report. J Bone Joint Surg Am. 2008;90(Suppl 3):52-56.
    9. Cooper HJ, Della Valle CJ. Large diameter femoral heads: is bigger always better? Bone Joint J. 2014 Nov;96-B(11 Supple A):23-6. doi: 10.1302/0301-620X.96B11.34342.