Global diversity in bearings in primary THA

Overview

This 2020 review in EFORT Open Reviews by Tsikandylakis, Overgaard, Zagra and Kärrholm examines how the choice of articulating materials, femoral head size and articulation design affects the long-term performance of total hip arthroplasty, especially the risks of dislocation and wear-related problems.

Who it is for

Hip arthroplasty surgeons, orthopaedic residents, registry researchers and anyone involved in implant selection for primary hip replacement.

Key areas covered

The review compares the main bearing combinations. Metal or ceramic heads on highly cross-linked polyethylene and ceramic-on-ceramic bearings show broadly similar revision risk, while metal-on-metal bearings, especially with large heads, perform worse. It discusses the uncertain clinical importance of ceramic squeaking and the rarity of ceramic fracture with current technology. It then weighs the trade-off of larger femoral heads: a greater range of motion before impingement and lower dislocation risk, against concerns about wear, taper corrosion and groin pain.

Notable emphasis

The authors review lipped liners, constrained liners and dual mobility cups as options to reduce revision for dislocation, noting that each carries implant-specific problems and that the evidence is weakened by selection bias. They call on the orthopaedic profession to run well-powered, multi-centre randomised trials to improve the evidence behind bearing choice.

How to use this guideline

The article frames choices and trade-offs rather than prescribing a single bearing. Readers should consult the full text for the head-size and material comparisons and weigh them against patient factors and surgical technique.