Abstract
Purpose
Dislocation after revision total hip is a common complication. The purpose of this study was to assess whether a large femoral head (36/40mm) would result in a decreased dislocation rate compared to a standard head (32mm).
Method
A randomized clinical trial was undertaken to assess the effect of large femoral heads on dislocation after revision total hip. Patients undergoing revision hip arthroplasty at seven centers were randomized to 32mm head or 36/40mm head. Patients were stratified according to surgeon. Primary endpoint was dislocation. Rates were compared with Fishers exact test. Secondary outcome measures were quality of life: WOMAC, SF-36 and satisfaction. One hundred eighty four patients were randomized: 92 in the 32mm head group and 92 in the large head group. Baseline demographics were similar in the two groups. Patients were followed from two to five years postoperatively
Results
In the large head group dislocation rate was 1.1% (1/92) versus 8.7% (8/92) for the 32mm head (p=0.035). In this study there was no difference in quality of life between the two groups.
Conclusion
This randomized clinical trial demonstrates that a large femoral head (36/40mm) can significantly reduce dislocation rate in patients undergoing revision total hip. As a result of this study the authors now routinely use large heads in all revision hip arthroplasty.
