Range of Motion and Stability in Total Hip Arthroplasty With 28-, 32-, 38-, and 44-mm Femoral Head Sizes

Burroughs, Brian R.; Hallstrom, Brian R.; Golladay, Gregory J.; Hoeffel, Daniel; Harris, William H.

doi:10.1016/j.arth.2004.07.008

Cited by 306 publications

(196 citation statements)

References 30 publications

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“…The use of large femoral heads (36, 38, or 40 mm) in THA offers several theoretical advantages, including decreased impingement, increased range of hip motion, and decreased risk of dislocation [4,5]. A reduced risk or elimination of dislocation of hips with larger femoral heads may result from decreased component-component or component-bone impingement and increased translation that is required for hip dislocation [4,15,21].…”

Section: Discussionmentioning

confidence: 99%

“…The concept that XLPE wear rates are independent of head size has led to the suggestion that larger femoral heads may be safely used in THA without increasing the production of particulate polyethylene debris that can lead to osteolysis and aseptic loosening [5]. The theoretical advantages of larger femoral head sizes are decreased component impingement, increased range of hip motion, and decreased risk of dislocation [4,21]. Two clinical studies evaluating the wear of XLPE with large femoral heads reported low linear wear rates at 3 years [1,14].…”

Section: Introductionmentioning

confidence: 99%

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Femoral Head Size and Wear of Highly Cross-linked Polyethylene at 5 to 8 Years

Lachiewicz

Heckman²,

Soileau

et al. 2009

Clin Orthop Relat Res

150

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Wear of highly cross-linked polyethylene is reportedly independent of head size. To confirm that observation we asked in our population whether head size related to wear with one type of electron beam highly cross-linked polyethylene. Of 146 hips implanted, we evaluated complete clinical and radiographic data for 90 patients (102 hips or 70%). The minimum followup was 5 years (mean, 5.7 years; range, 5-8 years). The head size was selected intraoperatively based on the size of the acetabular component and presumed risk of dislocation. Polyethylene wear measurements were performed in one experienced laboratory using the method of Martell et al.There was no hip with pelvic or femoral osteolysis. The median linear wear rate was 0.028 mm/year (mean, 0.04 mm/year), and the median volumetric wear rate was 25.6 mm 3 /year (mean, 80.5 mm 3 /year). Median total volumetric wear was 41.0 mm 3 (mean, 98.5 mm 3 ). We found no association between femoral head size and the linear wear rate, but observed an association between larger (36-and 40-mm) head size and volumetric wear rate and total volumetric wear. Although the linear wear rate of polyethylene was not related to femoral head diameter, there was greater volumetric wear (156.6 mm 3 /year) with the 36-and 40-mm heads. Pending long-term studies of large head sizes, we advise caution in using larger femoral heads in young or active patients and in those with a low risk of dislocation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Femoral Head Size and Wear of Highly Cross-linked Polyethylene at 5 to 8 Years

Lachiewicz

Heckman²,

Soileau

et al. 2009

Clin Orthop Relat Res

150

View full text Add to dashboard Cite

show abstract

“…The mechanical advantage of the large head and increased head-to-neck ratio in preventing dislocation is demonstrated in cadaveric and mathematical models [4,11,22], as well as in vitro studies [8,17].…”

Section: Introductionmentioning

confidence: 98%

The Frank Stinchfield Award: Dislocation in Revision THA: Do Large Heads (36 and 40 mm) Result in Reduced Dislocation Rates in a Randomized Clinical Trial?

Garbuz

Masri

Duncan

et al. 2012

Clinical Orthopaedics &Amp; Related Research

166

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Background Dislocation after revision THA is a common complication. Large heads have the potential to decrease dislocation rate, but it is unclear whether they do so in revision THA.Questions/purposes We therefore determined whether a large femoral head (36 and 40 mm) resulted in a decreased dislocation rate compared to a standard head (32 mm). Methods We randomized 184 patients undergoing revision THA to receive either a 32-mm head (92 patients) or 36-and 40-mm head (92 patients) and stratified patients by surgeon. The two groups had similar baseline demographics. The primary end point was dislocation. Qualityof-life (QOL) measures were WOMAC and SF-36. The mean followup for dislocation was 5 years (range, 2-7 years); the mean followup for QOL was 2.2 years (range, 1.6-4 years). Results In the 36-and 40-mm head group, the dislocation rate was 1.1% (one of 92) versus 8.7% (eight of 92) for the 32-mm head. There was no difference in QOL outcomes between the two groups. Conclusions Our observations confirm a large femoral head (36 or 40 mm) reduces dislocation rates in patients undergoing revision THA at short-term followup. We now routinely use large heads with a highly crosslinked polyethylene acetabular liner in all revision THAs.

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“…Factors implicated in hip dislocation include the patient's anatomy, implant design features, and surgical placement [1,5,6,8,11]. However, the magnitudes of the contributions of these factors, singly and in combination, are not fully known.…”

Section: Discussionmentioning

confidence: 99%

“…The ratio between the diameters of the head and neck affects the net ROM before impingement of the neck on the liner [6]. A larger head size increases the ROM and the distance the head has to translate before dislocating (sometimes called the ''jump distance'') [1,5,8]. The neck-shaft angle alters the position of the femoral shaft relative to the pelvis and can affect ROM.…”

Section: Introductionmentioning

confidence: 99%

Bony Impingement Limits Design-related Increases in Hip Range of Motion

Bunn

Colwell

D’Lima

2012

Clinical Orthopaedics &Amp; Related Research

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Background Factors affecting risk for impingement and dislocation can be related to the patient, implant design, or surgeon. While these have been studied independently, the impact of each factor relative to the others is not known. Questions/purposes We determined the effect of three implant design factors, prosthetic placement, and patient anatomy on subject-specific ROM. Methods We virtually implanted hip geometry obtained from 16 CT scans using computer models of hip components with differences in head size, neck diameter, and neck-shaft angle. A contact detection model computed ROM before prosthetic or bony impingement. We correlated anatomic measurements from pelvic radiographs with ROM.

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Range of Motion and Stability in Total Hip Arthroplasty With 28-, 32-, 38-, and 44-mm Femoral Head Sizes

Cited by 306 publications

References 30 publications

Femoral Head Size and Wear of Highly Cross-linked Polyethylene at 5 to 8 Years

Femoral Head Size and Wear of Highly Cross-linked Polyethylene at 5 to 8 Years

The Frank Stinchfield Award: Dislocation in Revision THA: Do Large Heads (36 and 40 mm) Result in Reduced Dislocation Rates in a Randomized Clinical Trial?

Bony Impingement Limits Design-related Increases in Hip Range of Motion

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