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.
RCT Entities:
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.
Authors: N Bellamy; J Kirwan; M Boers; P Brooks; V Strand; P Tugwell; R Altman; K Brandt; M Dougados; M Lequesne Journal: J Rheumatol Date: 1997-04 Impact factor: 4.666
Authors: P M Prodinger; J Schauwecker; H Mühlhofer; N Harrasser; F Pohlig; C Suren; R von Eisenhart-Rothe Journal: Orthopade Date: 2017-02 Impact factor: 1.087