The Journal of Bone and Joint Surgery (American) 84:256-263 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Jumbo Femoral Head for the Treatment of Recurrent Dislocation Following Total Hip Replacement
Paul E. Beaulé, MD, FRCSC,
Thomas P. Schmalzried, MD,
Pacharapol Udomkiat, MD and
Harlan C. Amstutz, MD
Investigation performed at the Joint Replacement Institute
at Orthopaedic Hospital, Los Angeles, California
Paul E. Beaulé, MD, FRCSC
Thomas P. Schmalzried, MD
Pacharapol Udomkiat, MD
Harlan C. Amstutz, MD
Joint Replacement Institute at Orthopaedic Hospital, 2400 South
Flower Street, Los Angeles, CA 90007
In support of their research or preparation of this manuscript, one
or more of the authors received grants or outside funding from Los
Angeles Orthopaedic Hospital Foundation. None of the authors received
payments or other benefits or a commitment or agreement to provide
such benefits from a commercial entity. No commercial entity paid
or directed, or agreed to pay or direct, any benefits to any research
fund, foundation, educational institution, or other charitable or
nonprofit organization with which the authors are affiliated or
associated.
Background: The purpose of this study was to
assess the results of the use of a jumbo femoral head to restore
stability in hips that had sustained recurrent dislocations after
total hip replacement.
Methods: Twelve hips in twelve patients who had
had multiple hip operations and recurrent instability of the hip
underwent a total hip replacement with use of a femoral head with
an average diameter of 44 mm (range, 40 to 50 mm). The average age of
the patients was fifty-nine years (range, twenty-nine
to eighty-four years). The twelve patients had had an average
of four previous operations (range, one to eight operations) and seven
dislocations (range, two to twenty dislocations). A bipolar head
was used in ten hips that had a femoral stem with a fixed (non-modular)
head, and a modular head (unipolar) was used in two hips. (One hip
was first treated with a bipolar head and then with a unipolar head.)
Results: One patient died of unrelated causes fourteen
months postoperatively. The hip had remained stable until the time
of death. After an average duration of follow-up of 6.5
years (range, 3.2 to 11.8 years), ten of the remaining eleven hips
had had no additional episodes of instability. One hip dislocated
within one week after the revision, necessitating revision surgery
to reposition the acetabular component. This hip was found to be stable
at the time of follow-up 7.6 years after the revision. There were
four other reoperations: one was done because of a fracture of the
polyethylene; one, because of entrapment of cement within the articulation;
one, because of pain related to loosening of the femoral stem; and
one, because of late hematogenous infection. The preoperative and
postoperative University of California at Los Angeles hip scores
for the series were, respectively, 7 and 9 points for pain, 5 and
7 points for walking, 4 and 6 points for function, and 3 and 5 points
for activity.
Conclusions: A jumbo-diameter femoral head provided
stability and improved function without compromising range of motion
in patients with recurrent dislocations following total hip arthroplasty.
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