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Low Early and Late Dislocation Rates with 36- and 40-mm Heads in Patients at High Risk for Dislocation

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Large (36- and 40-mm) femoral heads with highly crosslinked polyethylene liners were introduced to reduce the risk of dislocation after primary total hip arthroplasty (THA), but it is unclear whether the risk is reduced and whether there is osteolysis or liner fracture.

Questions/Purposes

We therefore determined (1) the incidence of early and late (> 5 years) dislocation; (2) the rate of femoral and acetabular component loosening and revision; and (3) the rate of liner fracture and pelvic osteolysis.

Methods

We retrospectively reviewed 112 patients presumed at high risk for dislocation who had 122 primary THAs: 108 with 36-mm and 14 with 40-mm femoral heads. The risk factors were: age > 75 years (80 hips); proximal femur fracture (18); history of contralateral dislocation (two); history of alcohol abuse (two); large acetabulum > 60 mm (six); and other (14). Patients were evaluated for early (< 1 year) and late (> 5 years) dislocation; rate of reoperation; clinical result with Harris hip score; and standard radiographic analysis for radiolucent lines and osteolysis.

Results

The rate of early dislocation was 4% (five of 122 hips), all with a 36-mm head. There were no late dislocations in 74 hips followed for 5 to 10 years, no revision for acetabular or femoral loosening, and no liner fractured. There were no hips with pelvic osteolysis and seven hips with an acetabular radiolucent line.

Conclusions

The 36- and 40-mm femoral heads were associated with a low risk of dislocation in high-risk patients undergoing primary THA with no osteolysis or liner fracture.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

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Acknowledgments

We thank Mr Stephen Perlman for his assistance in the literature review.

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Correspondence to Paul F. Lachiewicz MD.

Additional information

The institution of one of the authors (PFL) has received funding from Zimmer (Warsaw, IN, USA). Each author certifies that he or she, or a member of their immediate family, has no commercial associations that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Lachiewicz, P.F., Soileau, E.S. Low Early and Late Dislocation Rates with 36- and 40-mm Heads in Patients at High Risk for Dislocation. Clin Orthop Relat Res 471, 439–443 (2013). https://doi.org/10.1007/s11999-012-2379-3

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