Is there a reduction in risk of revision when 36-mm heads instead of 32 mm are used in total hip arthroplasty for patients with proximal femur fractures?

A matched analysis of 5,030 patients with a median of 2.5 years’ follow-up between 2006 and 2016 in the Nordic Arthroplasty Register Association

Authors

  • Georgios Tsikandylakis Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; The Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Dept of Orthopaedics, Gothenburg, Sweden
  • Johan N Kärrholm Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; The Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Dept of Orthopaedics, Gothenburg, Sweden
  • Geir Hallan The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, University of Bergen, Norway
  • Ove Furnes The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, University of Bergen, Norway
  • Antti Eskelinen Coxa Hospital of Joint Replacement, Tampere Finland; The Finnish Arthroplasty Register, Finland
  • Keijo Mäkelä The Finnish Arthroplasty Register, Finland; Department of Orthopaedics and Traumatology, Turku University Hospital, Finland
  • Alma B Pedersen Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; The Danish Hip Arthroplasty Register, Denmark
  • Søren Overgaard The Danish Hip Arthroplasty Register, Denmark; Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark;Institute of Clinical Research, University of Southern Denmark
  • Maziar Mohaddes Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; The Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Dept of Orthopaedics, Gothenburg, Sweden

DOI:

https://doi.org/10.1080/17453674.2020.1752559

Abstract

Background and purpose — 32-mm heads are widely used in total hip arthroplasty (THA) in Scandinavia, while the proportion of 36-mm heads is increasing as they are expected to increase THA stability. We investigated whether the use of 36-mm heads in THA after proximal femur fracture (PFF) is associated with a lower risk of revision compared with 32-mm heads.

Patients and methods — We included 5,030 patients operated with THA due to PFF with 32- or 36-mm heads from the Nordic Arthroplasty Register Association database. Each patient with a 36-mm head was matched with a patient with a 32-mm head, using propensity score. The patients were operated between 2006 and 2016, with a metal or ceramic head on a polyethylene bearing. Cox proportional hazards models were fitted to estimate the unadjusted and adjusted hazard ratio (HR) with 95% confidence intervals (CI) for revision for any reason and revision due to dislocation for 36-mm heads compared with 32-mm heads.

Results — 36-mm heads had an HR of 0.9 (CI 0.7–1.2) for revision for any reason and 0.8 (CI 0.5–1.3) for revision due to dislocation compared with 32-mm heads at a median follow-up of 2.5 years (interquartile range 1–4.4).

Interpretation — We were not able to demonstrate any clinically relevant reduction of the risk of THA revision for any reason or due to dislocation when 36-mm heads were used versus 32-mm. Residual confounding due to lack of data on patient comorbidities and body mass index could bias our results.

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Published

2020-04-14

How to Cite

Tsikandylakis, G., Kärrholm, J. N., Hallan, G. ., Furnes, O. ., Eskelinen, A. ., Mäkelä, K. ., … Mohaddes, M. . (2020). Is there a reduction in risk of revision when 36-mm heads instead of 32 mm are used in total hip arthroplasty for patients with proximal femur fractures? A matched analysis of 5,030 patients with a median of 2.5 years’ follow-up between 2006 and 2016 in the Nordic Arthroplasty Register Association. Acta Orthopaedica, 91(4), 401–407. https://doi.org/10.1080/17453674.2020.1752559