Revision for dislocation and all-causes following primary total hip replacement using 36-mm versus 32-mm femoral heads on polyethylene liners: a systematic review and meta-analysis
Farhan-Alanie, Muhamed M Abdul-Hussein, Mina Gallacher, Daniel Kumar, Prakrit R Sahemey, Rajpreet Wall, Peter D H Blankstein, Michael
Farhan-Alanie, Muhamed M
Abdul-Hussein, Mina
Gallacher, Daniel
Kumar, Prakrit R
Sahemey, Rajpreet
Wall, Peter D H
Blankstein, Michael
Affiliation
University of Warwick; Imperial College London; University of Birmingham; University Hospitals Birmingham NHS Foundation Trust; University of Vermont
Other Contributors
Publication date
2025-12-15
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Introduction: The use of a 36-mm femoral head in primary total hip replacement (THR) increases the jump distance and offers a wider impingement-free range of motion, theoretically reducing the risk of post-operative dislocation. However, concerns exist regarding its potentially greater impact on polyethylene wear and associated risks of liner fracture, aseptic loosening, and head-neck taper corrosion, compared to 32-mm femoral heads. This meta-analysis aims to compare the risk of revision for dislocation and all-causes when using 36-mm versus 32-mm metal or ceramic femoral heads with polyethylene liners for primary THR.
Methods: Medline, Embase, Web of Science, and the Cochrane Library were searched for relevant studies, while annual reports of arthroplasty registries were searched for relevant data. Random effects meta-analysis was performed. Sensitivity analysis was conducted, limiting to THR performed for osteoarthritis and using cross-linked polyethylene liners, or statistically adjusting for this factor. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID CRD42024557895).
Results: Four observational studies and two registry reports were identified. Median follow-up ranged from 2.1 to 4.7 years (inter-quartile range values spanned from 0.9 to 7.7 years). The main analyses demonstrated that 36-mm heads were associated with a marginal reduction in the risk of revision for dislocation (HR 0.85, 95%CI 0.72–1.01, p = 0.058; n = 241,136) without an increased risk of all-cause revision (HR 1.06, 95%CI 0.95–1.18, p = 0.287; n = 942,617). Similar results were observed in the sensitivity analyses.
Discussion: At early to midterm follow-up, the use of 36-mm heads were not associated with an increased risk of revision for all-causes, compared to 32-mm heads. However, they may offer a protective reduction against revision for dislocation, as a marginal statistically significant reduction was observed, indicating a possible benefit. Further studies investigating these outcomes at longer-term follow up are needed to understand whether these revision risk profiles are maintained.
Citation
Farhan-Alanie MM, Abdul-Hussein M, Gallacher D, Kumar PR, Sahemey R, Wall PDH, Blankstein M. Revision for dislocation and all-causes following primary total hip replacement using 36-mm versus 32-mm femoral heads on polyethylene liners: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2025 Dec 15;146(1):11. doi: 10.1007/s00402-025-06151-w.
Type
Article