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

• Published in: Acta orthopaedica 2020-07, Vol.91 (4), p.401-407
• Main Authors: Tsikandylakis, Georgios, Kärrholm, Johan N, Hallan, Geir, Furnes, Ove, Eskelinen, Antti, Mäkelä, Keijo, Pedersen, Alma B, Overgaard, Søren, Mohaddes, Maziar
• Format: Article
• Language: English
• Subjects: Orthopedics; Ortopedi
• ISSN: 1745-3674; 1745-3682
• DOI: 10.1080/17453674.2020.1752559

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.