Clinical Orthopaedics and Related Research®

, Volume 471, Issue 2, pp 439–443 | Cite as

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

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.

Notes

Acknowledgments

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

References

  1. 1.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.PubMedCrossRefGoogle Scholar
  2. 2.
    Bragdon CR, Greene ME, Freiberg AA, Harris WH, Malchau H. Radiostereometric analysis comparison of wear of highly cross-linked polyethylene against 36- vs 28-mm femoral heads. J Arthroplasty. 2007;22(Suppl 2):125–129.PubMedCrossRefGoogle Scholar
  3. 3.
    Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH. Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes. J Arthroplasty. 2005;20:11–19.PubMedCrossRefGoogle Scholar
  4. 4.
    Burroughs BR, Rubash HE, Harris WH. Femoral head sizes larger than 32 mm against highly cross-linked polyethylene. Clin Orthop Relat Res. 2002;405:150–157.PubMedCrossRefGoogle Scholar
  5. 5.
    Crowninshield RD, Maloney WJ, Wentz DH, Humphrey SM, Blanchard CR. Biomechanics of large femoral heads. Clin Orthop Relat Res. 2004;429:102–107.PubMedCrossRefGoogle Scholar
  6. 6.
    DeLee JG, Charnley J. Radiologic demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.PubMedGoogle Scholar
  7. 7.
    Geller JA, Malchau H, Bragdon C, Greene M, Harris WH, Freiberg AA. Large diameter femoral heads on highly cross-linked polyethylene. Clin Orthop Relat Res. 2006;447:53–59.PubMedCrossRefGoogle Scholar
  8. 8.
    Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end- result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMedGoogle Scholar
  9. 9.
    Jameson SS, Lees D, James P, Serrano-Pedraza I, Partington PF, Muller SD, Meek RMD, Reed MR. Lower rate of dislocation with increased femoral head size after primary total hip replacement. J Bone Joint Surg Br. 2011;93:876–880.PubMedCrossRefGoogle Scholar
  10. 10.
    Kelley SS, Lachiewicz PF, Hickman JM, Paterno SM. Relationship of femoral head and acetabular size to the prevalence of dislocation. Clin Orthop Relat Res. 1998;355:163–170.PubMedCrossRefGoogle Scholar
  11. 11.
    Krenzel BA, Berend ME, Malinzak RA, Faris PM, Keating EM, Meding JB, Ritter MA. High preoperative range of motion is a significant risk factor for dislocation in primary total hip arthroplasty. J Arthroplasty. 2010;25(Suppl 1):31–35.PubMedCrossRefGoogle Scholar
  12. 12.
    Lachiewicz PF, Heckman DS, Soileau ES, Mangla J, Martell JM. Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years. Clin Orthop Relat Res. 2009;467:3290–3296.PubMedCrossRefGoogle Scholar
  13. 13.
    Lachiewicz PF, Soileau ES. Stability of total hip arthroplasty in patients 75 years or older. Clin Orthop Relat Res. 2002;405:65–69.PubMedCrossRefGoogle Scholar
  14. 14.
    Lachiewicz PF, Soileau ES. Dislocation of primary total hip arthroplasty with 36 and 40 mm femoral heads. Clin Orthop Relat Res. 2006;453:153–155.PubMedCrossRefGoogle Scholar
  15. 15.
    Lombardi AV, Skeels MD, Berend KR, Adams JB, Franchi OJ. Do large femoral heads enhance stability and restore normal anatomy in primary total hip arthroplasty? Clin Orthop Relat Res. 2011;469:1547–1553.PubMedCrossRefGoogle Scholar
  16. 16.
    Maloney WJ, Herzwurm P, Paprosky W, Rubash HE, Engh CA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as part of a total hip replacement. J Bone Joint Surg Am. 2003;85:1111–1117.Google Scholar
  17. 17.
    Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration: an experimental study. J Arthroplasty. 1989;4:245–251.PubMedCrossRefGoogle Scholar
  18. 18.
    Paterno SA, Lachiewicz PF, Kelley SS. The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. J Bone Joint Surg Am. 1997;79:1202–1210.PubMedGoogle Scholar
  19. 19.
    Peters CL, McPherson E, Jackson JD, Erickson JA. Reduction in early dislocation rate with large-diameter femoral heads in primary total hip arthroplasty. J Arthroplasty. 2007;22(Suppl 2):140–144.PubMedCrossRefGoogle Scholar
  20. 20.
    Sykes CV, Lai LP, Schreiber M, Mont MA, Jinnah RH, Seyler TM. Instability after total hip arthroplasty. Treatment with large femoral heads vs constrained liners. J Arthroplasty. 2008;23(Suppl 1):59–63.CrossRefGoogle Scholar
  21. 21.
    Tower SS, Currier JH, Currier BH, Lyford KA, Van Citters DW, Mayor MB. Rim cracking of cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg Am. 2007;89:2212–2217.PubMedCrossRefGoogle Scholar
  22. 22.
    Von Knock M, Berry D. Late dislocation after total hip arthroplasty. J Bone Joint Surg Am. 2002;84:1949–1953.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  1. 1.Chapel Hill Orthopedics Surgery and Sports MedicineChapel HillUSA
  2. 2.Department of Orthopaedic SurgeryDuke University VA Medical CenterDurhamUSA

Personalised recommendations