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Georgios Tsikandylakis Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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Maziar Mohaddes Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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Peter Cnudde Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden
Department of Orthopaedics, Prince Philip Hospital, HDUHB, Wales

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Antti Eskelinen Coxa Hospital for Joint Replacement, Tampere, Finland
Finnish Arthroplasty Register, Helsinki, Finland

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Johan Kärrholm Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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Ola Rolfson Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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Introduction Total hip arthroplasty (THA) currently comprises a variety of head sizes and bearing types. The size of femoral head used in THA gradually increased from 22 mm in the 1960s to 28 mm in the 1990s, and thereafter to 32 mm in the mid

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Georgios Tsikandylakis Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden

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Soren Overgaard The Danish Hip Arthroplasty Register, Aarhus, Denmark
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Johan Kärrholm Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
The Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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standard in many countries. 4 Introduction of metal-on-metal articulations, ceramic-on-ceramic and, above all later on, highly cross-linked polyethylene opened the possibility for the use of bigger head sizes, but recent studies have suggested limited

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Francesco Benazzo Chirurgia Protesica ad Indirizzo Robotico, Fondazione Poliambulanza, Brescia, Italy

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Dante Dallari Reconstructive Orthopaedic Surgery and Innovative Techniques – Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Francesco Falez Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital, Rome, Italy

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Giuseppe Solarino Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, School of Medicine, University of Bari Aldo Moro, AOU Consorziale ‘Policlinico’, Bari, Italy

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Rocco D’Apolito Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Claudio Carlo Castelli FROM, Research Foundation Papa Giovanni XXIII Hospital, Bergamo, Italy

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of the cup. Bearing surfaces and femoral head size selection THA bearing surfaces are susceptible to edge loading, and an abnormal hip–spine relationship increases its occurrence significantly. Posterior edge loading can occur during hip

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Olivier Guyen Department of Orthopaedic Surgery, Lausanne University Hospital, Lausanne, Switzerland

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system provides a greater effective head size and improved head-to-neck ratio ( Fig. 5 ). Dual mobility is therefore expected to improve the ROM to impingement and joint stability. Laboratory studies have confirmed this assumption and have emphasised the

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Hanna Wellauer Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland
Division of Orthopaedics and Trauma Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland

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Roman Heuberger RMS Foundation, Bettlach, Switzerland

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Emanuel Gautier Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland

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Moritz Tannast Department of Orthopaedic Surgery and Traumatology, HFR Fribourg Hospital, University of Fribourg, Fribourg, Switzerland

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Hubert Steinke Institute for the History of Medicine, University of Bern, Bern, Switzerland

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Peter Wahl Division of Orthopaedics and Trauma Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
Faculty of Medicine, University of Berne, Berne, Switzerland

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stainless steel due to wear issues and finally in 1974 by aluminium oxide ceramic heads ( 17 , 19 ). Nevertheless, no long-term advantages could be shown regarding the rotating neck ( 20 ). However, as the head sizes of 32 mm were innovative at that time

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Theofilos Karachalios School of Health Sciences, Faculty of Medicine, University of Thessalia, University General Hospital of Larissa, Mezourlo Region, 41110 Larissa, Greece

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George Komnos Orthopaedic Department, University General Hospital of Larissa, Greece

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Antonios Koutalos Orthopaedic Department, University General Hospital of Larissa, Greece

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. Evaluating surgical and implant-related factors, cemented, cementless, hybrid fixation and head size proved not to be risk factors (due to confounding factors). For healthcare factors, low volume hospitals and low volume surgeons were risk factors for

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Michael M. Morlock TUHH Hamburg University of Technology, Hamburg, Germany.

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Robert Hube OCM Clinic Munich, Munich, Germany

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Georgi Wassilew Department for Orthopaedics and Orthopaedic Surgery, University of Greifswald, Greifswald, Germany

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Felix Prange TUHH Hamburg University of Technology, Hamburg, Germany.

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Gerd Huber TUHH Hamburg University of Technology, Hamburg, Germany.

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Carsten Perka Center for Musculoskeletal Surgery, Orthopedic Department, Charité – Universitätsmedizin Berlin, Berlin, Germany

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polyethylene (PE), metal-on-metal (MoM) hard-on-hard articulations started to become popular to enable larger head sizes. Opposite to PE bearings, the amount of wear in MoM bearings decreases with head size – as long as they are lubricated properly. This was

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Feng Xie The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China

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Shuya Sheng Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK

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Jeya Palan Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK

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Hemant G Pandit Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK

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al. ( 49 ) reported a survival rate of 97% in males and 80% in females at 10 years. The majority of failures had a head size of 46 mm or less (64%), but this was not found to be statistically significant. Samuel et al. ( 38 ) also reported that

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Mattia Loppini Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona – Università degli Studi di Genova, Savona, Italy

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Francesco Manlio Gambaro Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

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Rob G H H Nelissen Landelijke Registratie Orthopedische Implantaten (Dutch Arthroplasty Register), ’s Hertogenbosch, The Netherlands
Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands

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Guido Grappiolo IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona – Università degli Studi di Genova, Savona, Italy

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for special cases such as metal-on-metal (MoM) THA or small head size ( 5 , 12 , 13 ). Concerning the quality of evidence behind them, these guidelines were not evidence based but drafted from expert consensus. Therefore, the level of recommendation

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Geke A. W. Denissen Landelijke Registratie Orthopedische Implantaten (Dutch Arthroplasty Register), ’s Hertogenbosch, The Netherlands

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Liza N. van Steenbergen Landelijke Registratie Orthopedische Implantaten (Dutch Arthroplasty Register), ’s Hertogenbosch, The Netherlands

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Wouter T. Lollinga Landelijke Registratie Orthopedische Implantaten (Dutch Arthroplasty Register), ’s Hertogenbosch, The Netherlands

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Nico J. J. Verdonschot Dept. of Biomechanics, Radboud University Medical Center, Nijmegen, The Netherlands
Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands

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Berend W. Schreurs Landelijke Registratie Orthopedische Implantaten (Dutch Arthroplasty Register), ’s Hertogenbosch, The Netherlands
Dept. of Orthopaedics, Radboud University Medical Center, Nijmegen, The Netherlands

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Rob G. H. H. Nelissen Landelijke Registratie Orthopedische Implantaten (Dutch Arthroplasty Register), ’s Hertogenbosch, The Netherlands
Dept. of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands

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opportunity for researchers to assess how implant characteristics like type of articulation, femoral head size, stem shape or stem surface affect prosthesis survival. Prostheses can be grouped according to a specific generic characteristic present in several

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