Pairing 40-mm Femoral Heads With the Smallest Compatible Acetabular Components in Total Hip Arthroplasty: Mid-Term Outcomes in 177 Cases

Brandon R. Bukowski, Courtney E. Baker, Matthew P. Abdel, Robert T. Trousdale

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Contemporary total hip arthroplasty (THA) often employs larger femoral heads to optimize hip stability. However, pairing 40-mm femoral heads with the smallest compatible acetabular components poses a potential risk for implant failure. The purpose of this study is to evaluate the outcomes of primary THAs using 40-mm femoral heads and the smallest compatible acetabular components. Methods: Between 2007 and 2018, 177 primary THAs involving 40-mm femoral heads and acetabular components ≤56 mm with highly cross-linked polyethylene liners were identified. Mean age was 61 years, 56% were females, and mean body mass index was 32 kg/m2. Cumulative incidences of dislocation, any revision, and any reoperation were determined utilizing a competing risk model. Osteolysis and femoral head penetration were assessed at minimum 8-year follow-up (n = 16). Mean follow-up was 6 years. Results: There were no cases of liner fractures or dissociations. The 10-year cumulative incidences of dislocation, any revision, and any reoperation were 3.6%, 4.2%, and 6.8%, respectively. Mean linear femoral head penetration was 0.01 mm/y and mean volumetric wear rate was 50 mm3/y. One THA demonstrated stable, asymptomatic periacetabular radiolucent lines at most recent follow-up. Conclusion: In 177 primary THAs pairing 40-mm femoral heads with the smallest compatible acetabular components, there were no liner fractures or dissociations. The cumulative incidence of dislocation was modest at 10 years. The cumulative incidences of any revision and any reoperation were low at mid-term. Level of Evidence: IV.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - 2022

Keywords

  • highly crosslinked polyethylene
  • large femoral heads
  • polyethylene wear
  • small acetabular components
  • total hip arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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