Large Femoral Heads Decrease the Incidence of Dislocation After Total Hip Arthroplasty: A Randomized Controlled Trial

BACKGROUND:The use of larger femoral heads has been proposed to reduce the risk of dislocation after total hip arthroplasty, but there is a lack of evidence to support this proposal. The aim of this multicenter randomized controlled trial was to determine whether the incidence of dislocation one yea...

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Bibliographic Details
Published in:Journal of bone and joint surgery. American volume 2012-06, Vol.94 (12), p.1095-1102
Main Authors: Howie, Donald W, Holubowycz, Oksana T, Middleton, Robert
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip - instrumentation
Biological and medical sciences
Cohort Studies
Diseases of the osteoarticular system
Female
Femur Head
Hip Dislocation - diagnosis
Hip Dislocation - epidemiology
Hip Dislocation - prevention & control
Hip Prosthesis
Humans
Incidence
Male
Medical sciences
Middle Aged
Orthopedic surgery
Osteoarthritis, Hip - surgery
Prosthesis Design
Prosthesis Failure
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
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Summary:BACKGROUND:The use of larger femoral heads has been proposed to reduce the risk of dislocation after total hip arthroplasty, but there is a lack of evidence to support this proposal. The aim of this multicenter randomized controlled trial was to determine whether the incidence of dislocation one year after total hip arthroplasty is significantly lower in association with the use of a 36-mm femoral head articulation as compared with a 28-mm articulation. METHODS:Six hundred and forty-four middle-aged and elderly patients undergoing primary or revision arthroplasty were randomized intraoperatively to receive either a 36 or 28-mm metal femoral head on highly cross-linked polyethylene. Patients who were at high risk of dislocation (including those with dementia and neuromuscular disease) and those undergoing revision for the treatment of recurrent hip dislocation or infection were excluded. Patients were stratified according to other potential risk factors for dislocation, including diagnosis and age. Diagnosis of hip dislocation required confirmation by a physician and radiographic evidence of a dislocation. RESULTS:Overall, at one year of follow-up, hips with a 36-mm femoral head articulation had a significantly lower incidence of dislocation than did those with a 28-mm articulation (1.3% [four of 299] compared with 5.4% [seventeen of 316]; difference, 4.1% [95% confidence interval, 1.2% to 7.2%]) when controlling for the type of procedure (primary or revision) (p = 0.012). The incidence of dislocation following primary arthroplasty was also significantly lower for hips with a 36-mm femoral head articulation than for those with a 28-mm articulation (0.8% [two of 258] compared with 4.4% [twelve of 275]; difference, 3.6% [95% confidence interval, 0.9% to 6.8%]) (p = 0.024). The incidence of dislocation following revision arthroplasty was 4.9% (two of forty-one) for hips with a 36-mm articulation and 12.2% (five of forty-one) for hips with a 28-mm articulation; this difference was not significant with the relatively small sample size of the revision group (difference, 7.3% [95% confidence interval, −5.9% to 21.1%]) (p = 0.273). CONCLUSIONS:Compared with a 28-mm femoral head articulation, a larger 36-mm articulation resulted in a significantly decreased incidence of dislocation in the first year following primary total hip arthroplasty. However, before a 36-mm metal-on-highly cross-linked polyethylene articulation is widely recommended, the incidence of late dis
ISSN:0021-9355
1535-1386
DOI:10.2106/JBJS.K.00570