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Updated: Sep 23, 2026
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
There Is No One-Size-Fits-All: Surgical Approach Dictates Optimal Bearing Surface Configuration Choice in 30,000
Niall H Cochrane1, Joseph A Panos1, Monty S Khela1
1Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905, Phone: (507) 284-2884, Fax: (507) 266-4234.
Introduction:
Dislocation remains a consequential complication following primary total hip arthroplasty (THA). Both surgical approach and bearing surface configuration individually influence dislocation risk. This study assessed the dislocation risk stratified by both surgical approach and bearing surface configuration to develop approach-specific recommendations for bearing selection.
Methods:
We identified 30,246 primary THAs performed from 1998 to 2022 at a single academic institution. Hips were stratified by bearing surface configuration, including flat/neutral polyethylene (PE) liners, elevated rim/face-changing (elevated) PE liners, and dual-mobility (DM) constructs. There were 14,611 posterior hips (8,587 flat/neutral, 5,207 elevated, and 816 DM), 8,968 antero-lateral (AL, 7,433 flat/neutral, 1,358 elevated, and 171 DM), and 6,667 direct anterior (DA, 6,541 flat/neutral, 91 elevated, and 35 DM). The mean age was 65 years (range, 18 to 100), the mean body mass index was 30 (range, 13 to 66), and 52% were women. The mean follow-up was six years (range, two to 26).
Results:
The survivorship free of dislocation at 10 years in the posterior, AL, and DA approach THAs were 96, 98, 99%, respectively. In posterior THAs, DM constructs reduced the relative risk of dislocation (RR [risk ratio] < 0.5, P < 0.01). In AL THAs, flat/neutral PE liners had a 99% survivorship free of dislocation, whereas elevated PE liners had double the relative risk of dislocation (RR 2, P < 0.01). In DA THAs, the bearing surface configuration had no discernible impact on the relative risk of dislocation.
Conclusion:
A one-size-fits-all approach to bearing surface configuration is not supported, and a surgical approach should guide bearing selection in primary THAs. For posterior approach THA, DM constructs should be considered in high-risk cases. For the AL approach THA, flat/neutral PE liners had the lowest absolute dislocation risk. Direct anterior THA had the lowest risk of dislocation risk, regardless of bearing selection.
