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Related Experiment Video

Updated: Mar 16, 2026

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
09:31

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

Published on: February 27, 2018

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Large-diameter total hip arthroplasty modular heads require greater assembly forces for initial stability.

A R MacLeod1, N P T Sullivan2, M R Whitehouse3

  • 1University of Bath, Claverton Down Rd, Bath, North East Somerset BA2 7AY, UK.

Bone & Joint Research
|August 7, 2016
PubMed
Summary

Larger 36mm hip arthroplasty heads show significantly lower connection strength than 28mm heads. This finding suggests that increased assembly forces are needed for larger diameter heads to ensure initial stability in total hip replacements.

Keywords:
ConnectionHead SizePull-offStrengthTaperTrunnion

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Area of Science:

  • Orthopaedic surgery
  • Biomaterials engineering
  • Implant biomechanics

Background:

  • Modular junctions are critical in modern hip arthroplasty.
  • Large diameter metal-on-metal (MoM) hip failures are linked to head-trunnion junction issues, leading to significant litigation.
  • Factors influencing modular connection strength are known, but head size impact was unstudied.

Purpose of the Study:

  • To investigate if varying head sizes influence the initial strength of the trunnion-head connection in hip arthroplasty.
  • To compare the pull-off forces between 28mm and 36mm cobalt-chromium heads assembled onto titanium alloy trunnions.

Main Methods:

  • Sixty Ti-6Al-4V trunnions and 60 cobalt-chromium heads (28mm and 36mm) were tested.
  • Assembly forces of 4 kN, 5 kN, and 6 kN were applied.
  • Pull-off force was measured to evaluate connection strength; statistical analysis and finite element modeling were used.

Main Results:

  • 36mm heads exhibited significantly lower pull-off forces than 28mm heads at 4 kN and 5 kN assembly forces (p < 0.001).
  • Mean pull-off forces were approximately 20% higher for 28mm heads compared to 36mm heads at these forces.
  • Finite element and analytical models confirmed that differences in structural rigidity and interface pressures explain the observed strength variations.

Conclusions:

  • This study is the first to demonstrate that 36mm heads have up to 20% lower pull-off strength than 28mm heads at equivalent assembly forces.
  • The reduced connection strength of larger heads may contribute to the high failure rates observed in large diameter MoM hip implants.
  • Greater assembly forces may be required for larger diameter modular heads to achieve adequate initial stability in total hip arthroplasty.