Dislocation after total hip arthroplasty with 28 and 32-mm femoral head

Background Dislocation after primary total hip arthroplasty (THA) is a significant complication that occurs in 2-5% of patients. It has been postulated that increasing the femoral head diameter may reduce the risk of dislocation. The purpose of this paper is to report our experiences with a change from a 28 to a 32-mm femoral head. Materials and methods The retrospective cohort study includes 2572 primary THA performed with a 28 or 32 mm diameter femoral head in the period February 2002 to July 2009. All patients were operated with a posterolateral approach, and all except 18 were operated because of osteoarthritis. Cemented stems were used in 1991 cases and uncemented stems in 581 cases. Cemented cups were used in 2,230 cases and uncemented cups in 342 cases. The patients have been routinely followed for 1-8 years in the 28-mm femoral head group and from 0.5-7.5 years in the 32 femoral head group. We defined a dislocation as an event in which the hip required reduction by a physician. Results Dislocation occurred in 49 hips with a 28-mm femoral head and in 4 hips with a 32-mm femoral head with an odds ratio of 6.06 (95% CI = 2.05-17.8) (P < 0.001). Otherwise, there were no significant associations between sex, age, diagnosis and type of prosthesis. Conclusions Multivariate analyses of patients operated at our hospital indicate a significant association between femoral head diameter and dislocation after THA. There were no significant associations between dislocation and sex, age, diagnosis, or type of prosthesis.