Introduction Ceramic femoral heads with titanium sleeves (TS) are used in revision total hip arthroplasty (THA) with femoral component retention to reduce risk of femoral head fracture and trunnion corrosion. Their utility in primary THA, particularly for larger heads, is unknown. We sought to evaluate the influence of TSs on the risk of rTHA after primary THA when 36mm and 40mm ceramic heads were utilized. Methods All primary THAs using ceramic heads (n=213,749) reported to the American Joint Replacement Registry (AJRR) from January 2012 to December 2021 in patients ≥65 years old with minimum 2-year follow-up were analyzed. THAs were categorized as using ≤28mm (millimeter), 32mm, 36mm, or ≥40mm femoral heads. Nine percent of cases (n=18,685) utilized TS. Cause-specific Cox models were used to determine risk of all-cause revision, accounting for age, sex, body mass index, and Charlson Comorbidity Index. Results Femoral head size influenced the outcome of all-cause revision based on the presence of TS (p=0.013). Thirty-six mm heads with TS had a higher all-cause revision rate compared to 36mm heads without TS (HR 1.34, 95% CI 1.13–1.59, p<0.001), driven by increased rates of revision for dislocation. Femoral heads ≥40mm without TS had a higher all-cause revision rate compared to 36mm heads without TS (HR 1.28, 95% CI 1.07–1.54, p<0.008), driven by increased rates of revision for infection, dislocation, wear, and mechanical complications. There was no difference, with the numbers available, in all-cause revision between ≥40mm heads with TS and 36mm heads without TS (HR 1.00, 95% CI 0.70–1.44, p=0.991). Conclusion The use of TS is associated with an increased risk of revision with 36mm ceramic femoral heads, but may improve survivorship for ≥40mm heads in primary THA. Ultimately, the risk of revision appears to be most influenced by head size. Orthopaedic surgeons should consider using TS when utilizing ≥40mm ceramic femoral heads in primary THA.
Sanchez et al. (Thu,) studied this question.