Go Big or Go Home! Lower Risk of Revision with Bigger Femoral Heads in Primary Total Hip Replacement: A Comparative Single-Centre Study (10,104 Hips)

Description

In this presentation delivered by Jonathan France in Nottingham, the focus is on the research into the impact of femoral head sizes on the risk of revision surgery following total hip replacements (THR). The study examines whether larger femoral head sizes can reduce dislocation risks, a common and serious complication that leads to a high rate of revisions, particularly in the first four years following surgery.



France discusses the background of THR, describing it as a highly successful procedure yet still susceptible to complications, particularly dislocations which are cited as the leading cause of revisions. By utilizing larger femoral heads, theorized benefits include enhanced stability and an increased range of movement while also addressing dislocation risk. However, the presentation explains the potential drawbacks of larger heads, including increased frictional torque, risks of trunnionosis, and variations in polyethylene insert size which could lead to wear and other issues.



The research methodology involves retrospective analysis of over 10,000 hip replacements conducted at the center over a 16-year period, considering factors such as age, gender, approach to surgery, and head sizes (28mm, 32mm, and 36mm). Statistical analyses, specifically Kaplan-Meier survival curves, were used to determine outcomes over the follow-up period.



Results indicate a significant correlation between larger head size and lower revision rates, particularly noting the 36mm head showed the lowest overall revision rate. Kaplan-Meier estimates indicated higher survivorship rates associated with larger head sizes, highlighting significant differences in outcomes between the 28mm and the larger heads. Despite theoretical concerns regarding larger heads, no substantial increase in revisions for other causes was observed.



In conclusion, the findings suggest that opting for a 32mm or 36mm femoral head can significantly reduce revision risks related to dislocation without notable negative consequences, emphasizing the importance of head size selection in THR procedures. The presentation underlines a vital consideration for surgical choices in orthopedic hip replacements.

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