Survival and outcomes of different head sizes in primary total hip arthroplasty

The femoral head size influences dislocation, range of motion (ROM), functional outcome, wear, and survival after total hip arthroplasty (THA). These aspects of different head sizes with contemporary bearings in primary THA have been reviewed. Based on the existing evidence, for highly-cross-linked polyethylene (HXLPE) bearings, a 32 mm cobalt chromium (CoCr) or ceramic head appears to be a suitable choice. If a 36 mm head with HXLPE is desired, a ceramic head may be preferable over CoCr due to reduced risk of fretting and corrosion with the former. For ceramic-on-ceramic (CoC) bearings, head sizes >36 mm do not appear to provide any significant benefit over 36 mm heads. Also, large ceramic heads may lead to increased risk of squeaking. If non-cross-linked PE bearing is considered for use, it would be prudent to opt for <32 mm head size.