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Bones of the Lower Limb: Femur and Patella

Bones of the Lower Limb: Femur and Patella

The femur is the body's longest and strongest bone spanning the thigh region. Its head articulates with the acetabulum of the hip bone to form the hip joint. A minor indentation on the medial side of the femoral head, called the fovea capitis, serves as the site of attachment for the ligament of the head of the femur. This weak ligament spans the femur and acetabulum and supports the hip joint. The narrowed region below the head is the neck of the femur. The inclination angle between the neck...

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Updated: May 21, 2026

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

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Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled

Donald W Howie¹, Oksana T Holubowycz, Robert Middleton

¹Department of Orthopaedics and Trauma, Level 4, Bice Building, North Terrace, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.

The Journal of Bone and Joint Surgery. American Volume

|June 22, 2012

Summary

Using a larger 36-mm femoral head in total hip arthroplasty significantly reduces dislocation risk compared to a 28-mm head, particularly in primary procedures. Further research is needed for long-term outcomes.

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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Published on: February 27, 2018

Area of Science:

Orthopedic Surgery
Biomedical Engineering

Background:

Total hip arthroplasty (THA) aims to restore function and reduce pain.
Dislocation remains a significant complication following THA.
Larger femoral head sizes have been theorized to improve stability and reduce dislocation rates.

Purpose of the Study:

To evaluate the efficacy of a 36-mm femoral head articulation versus a 28-mm articulation in reducing dislocation incidence after THA.
To compare dislocation rates between primary and revision THA procedures using different femoral head sizes.

Main Methods:

A multicenter randomized controlled trial involving 644 patients undergoing primary or revision THA.
Patients were randomized to receive either a 36-mm or 28-mm metal femoral head on highly cross-linked polyethylene.
Exclusion criteria included high-risk factors for dislocation and prior revision for dislocation or infection.

Main Results:

A significantly lower incidence of dislocation was observed at one year with the 36-mm head (1.3%) compared to the 28-mm head (5.4%) (p=0.012).
For primary THA, the 36-mm head showed a significantly lower dislocation rate (0.8%) versus the 28-mm head (4.4%) (p=0.024).
The difference in dislocation rates for revision THA was not statistically significant between the 36-mm (4.9%) and 28-mm (12.2%) groups due to sample size limitations.

Conclusions:

A 36-mm femoral head articulation significantly decreases the one-year incidence of dislocation following primary total hip arthroplasty compared to a 28-mm articulation.
Long-term data on wear, osteolysis, and fracture are necessary before widespread recommendation of 36-mm metal-on-highly cross-linked polyethylene articulations.