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Metal-on-metal designs allow the use of large heads that decrease impingement and improve stability.
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The use of metal-on-metal led to resurfacing hip replacements and to the use of large head metal-on-metal hip replacements.
In the surgical therapy of recurrent dislocation, we now prefer the use of large head implants.
This increase in stemmed metal-on-metal was almost entirely because of the use of large head sizes.
This is why the use of large head diameters leads to less important jumping distances than those expected.
However, the literature on the use of large head diameters in revision surgery (Beaule et al. 2002, Amstutz et al. 2004, Fricka et al. 2006, Kung and Riers 2007) still shows a failure rate of between88% and 40%, with no statistically significant difference between standard femoral head sizes (28, 32 mm) and large ones (Kung and Riers 2007).
Our study confirms and expands on previously published evidence that the dislocation rate is reduced by use of larger heads.
Current manufacturing advancement allow the use of larger head diameters with ceramic monoblock acetabular components.
Our overall clinical experience with the use of large-head MoM was poor with a 10% failure rate at just under three years, with the majority of failures secondary to aseptic loosening of the acetabular component.
The Medicare database showed that the use of larger head sizes (32 mm or greater) over the course of a decade resulted in a decrease in dislocation rate of about 50% [ 56].
This increase in the use of large diameter heads reflects the literature which states that larger heads reduce the rate of THR dislocation [23, 24].
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