Choosing a Femoral Head: A Survey Study of Academic Adult Reconstructive Surgeons

Our aim was to examine how academic adult reconstructive surgeons have interpreted evidence on femoral head material in total hip arthroplasty (THA).

A 16-question survey to evaluate attitudes toward ceramic and cobalt-chrome head use was emailed to 274 faculty at 42 US adult reconstruction fellowship programs.

With 116 respondents, the response rate was 42.2%. Faculty use ceramic heads 72.9% of the time. The most common reason why respondents do not use ceramic heads is cost (44.8%). Ninety-four percent of faculty have observed head-neck taper corrosion in cobalt-chrome on polyethylene THA, while 9.5% of faculty have observed head-neck taper corrosion in ceramic on polyethylene THA. Only 6.0% of surgeons have seen Biolox Delta ceramic fracture.

Adult reconstruction thought leaders are guided by evidence suggesting that with ceramic heads, taper corrosion and fracture are rare. Cost and personal experience also strongly influence their implant selection. Efforts to equalize cost of ceramic and cobalt-chrome heads may free surgeons to practice in a purely evidence-based fashion.