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?
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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.
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).
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).
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.
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.
The authors thank the following for recruiting patients: Dr. David Backstein, MD, MED, FRCSC, at Mount Sinai Hospital in Toronto, Canada; Dr. Colin Burnell, MD, FRCSC, Dr. David Hedden MD, FRCSC, and Dr. Thomas Turgeon, MD, MPH, FRCSC, at the University of Manitoba in Winnipeg, Canada; Dr. Scott Sporer, MD, at Rush University Medical Center in Chicago, IL, USA; Dr. Steven H. Weeden, MD, at the Texas Hip & Knee Center in Fort Worth, TX, USA; Dr. Paul Kim, MD, FRCSC, at the University of Ottawa, Canada; and Dr. Michael J. Dunbar, MD, PhD, FRCPC, at Dalhousie University in Halifax, Canada. The authors also thank Lorna McLean, Daphné Savoy, Matthew MacDonald, Sarah Tran, Emily Dittle, Carly Valdez, Heather Belanger, and Sue Moore for patient recruitment and study coordination and Eric Sayre, PhD, for his help with the statistical analysis.
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