Symposium: Papers Presented at the Annual Meetings of The Hip Society

Clinical Orthopaedics and Related Research®

, Volume 470, Issue 2, pp 351-356

The Frank Stinchfield Award: Dislocation in Revision THA: Do Large Heads (36 and 40 mm) Result in Reduced Dislocation Rates in a Randomized Clinical Trial?

  • Donald S. GarbuzAffiliated withDepartment of Orthopaedics, University of British Columbia Email author 
  • , Bassam A. MasriAffiliated withDepartment of Orthopaedics, University of British Columbia
  • , Clive P. DuncanAffiliated withDepartment of Orthopaedics, University of British Columbia
  • , Nelson V. GreidanusAffiliated withDepartment of Orthopaedics, University of British Columbia
  • , Eric R. BohmAffiliated withUniversity of Manitoba Joint Replacement Group, Concordia Hospital
  • , Martin J. PetrakAffiliated withUniversity of Manitoba Joint Replacement Group, Concordia Hospital
  • , Craig J. Della ValleAffiliated withDepartment of Orthopaedic Surgery, Rush University Medical Center
  • , Allan E. GrossAffiliated withDivision of Orthopaedic Surgery, Mount Sinai Hospital

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Abstract

Background

Dislocation after revision THA is a common complication. Large heads have the potential to decrease dislocation rate, but it is unclear whether they do so in revision THA.

Questions/purposes

We therefore determined whether a large femoral head (36 and 40 mm) resulted in a decreased dislocation rate compared to a standard head (32 mm).

Methods

We randomized 184 patients undergoing revision THA to receive either a 32-mm head (92 patients) or 36- and 40-mm head (92 patients) and stratified patients by surgeon. The two groups had similar baseline demographics. The primary end point was dislocation. Quality-of-life (QOL) measures were WOMAC and SF-36. The mean followup for dislocation was 5 years (range, 2–7 years); the mean followup for QOL was 2.2 years (range, 1.6–4 years).

Results

In the 36- and 40-mm head group, the dislocation rate was 1.1% (one of 92) versus 8.7% (eight of 92) for the 32-mm head. There was no difference in QOL outcomes between the two groups.

Conclusions

Our observations confirm a large femoral head (36 or 40 mm) reduces dislocation rates in patients undergoing revision THA at short-term followup. We now routinely use large heads with a highly crosslinked polyethylene acetabular liner in all revision THAs.

Level of Evidence

Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.