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Related Experiment Video

Updated: Feb 8, 2026

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
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Head size in primary total hip arthroplasty.

Georgios Tsikandylakis1,2,3, Maziar Mohaddes1,2,3, Peter Cnudde2,3,4

  • 1Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.

EFORT Open Reviews
|June 29, 2018
PubMed
Summary

Larger femoral head sizes in total hip arthroplasty (THA) do not improve function but may increase wear. A 32 mm head is recommended for metal-on-polyethylene implants, while ceramic options offer safety with larger sizes.

Keywords:
dislocationhead sizehip arthroplastylarge bearingrevision

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Medical Engineering

Background:

  • The use of larger femoral head sizes (32 mm and 36 mm) in total hip arthroplasty (THA) has become increasingly common over the last decade.
  • This trend presents a potential trade-off between improved hip stability and potentially reduced long-term implant survival.

Purpose of the Study:

  • To review the current literature on the benefits and complications associated with the increasing use of larger femoral head sizes in THA.
  • To evaluate the impact of femoral head size on hip range of motion, function, dislocation risk, wear, and long-term survivorship.

Main Methods:

  • A comprehensive literature review was conducted, focusing primarily on studies published within the last five years.
  • The review analyzed data regarding femoral head sizes, bearing materials (metal-on-cross-linked polyethylene and ceramic-on-cross-linked polyethylene), and clinical outcomes such as dislocation, wear, and implant survivorship.

Main Results:

  • Femoral head sizes exceeding 36 mm offer no discernible benefits in hip range of motion or overall function.
  • While larger heads (≥36 mm) reduce the risk of dislocation compared to smaller ones (≤28 mm), volumetric wear and frictional torque increase with heads >32 mm in metal-on-polyethylene articulations.
  • Long-term survivorship is enhanced with 32 mm metal-on-cross-linked polyethylene bearings compared to both smaller and larger sizes.

Conclusions:

  • For metal-on-cross-linked polyethylene bearings in THA, a 32 mm femoral head size is recommended to optimize long-term survivorship and minimize wear.
  • In cases utilizing larger femoral head sizes, ceramic-on-cross-linked polyethylene bearings appear to be a safer option, mitigating risks associated with increased wear.