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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?

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

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.

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Acknowledgments

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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Authors and Affiliations

Authors

Corresponding author

Correspondence to Donald S. Garbuz MD, MHSc.

Additional information

Each author (DSG, BAM, CPD, AEG) certifies that he or she has or may receive payments or benefits (e.g, serve as a consultant) from a commercial entity (Zimmer, Inc, Warsaw, IN, USA) related to this work. Each author (NVG, ERB, MJP, CDV) certifies that he or she has no commercial associations (e.g, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The institution of the authors (DSG, BAM, CPD, NVG, CDV) has received funding from Zimmer, Inc.

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 before 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.

This work was performed at the University of British Columbia; the University of Manitoba; Rush University Medical Center; and Mount Sinai Hospital.

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Garbuz, D.S., Masri, B.A., Duncan, C.P. et al. 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?. Clin Orthop Relat Res 470, 351–356 (2012). https://doi.org/10.1007/s11999-011-2146-x

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