Minimum Two-Year Survivorship of Large Femoral Heads With Titanium Sleeves in Primary Total Hip Arthroplasty: An Analysis From the American Joint Replacement Registry.

Abstract

Ceramic femoral heads with titanium sleeves (TSs) are used in revision total hip arthroplasty (THA) with femoral component retention to reduce the 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 revision total hip arthroplasty based on ceramic head size. All primary THAs using ceramic heads (n = 213,749) reported to the American Joint Replacement Registry from January 2012 to December 2021 in patients at least 65 year old who had a minimum 2-year follow-up were analyzed. The THAs were categorized as using ≤ 28 mm (millimeter), 32 mm, 36 mm, or ≥ 40 mm femoral heads. There were 9% of the cases (n = 18,685) that utilized TS. Cause-specific Cox models were used to determine the risk of all-cause revision, accounting for age, sex, body mass index, and the Charlson Comorbidity Index. Femoral head size influenced all-cause revision based on the presence of TS (P = 0.013). The 36 mm heads with TS had a higher all-cause revision rate than the 36 mm heads without TS (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.13 to 1.59, P < 0.001), driven by increased rates of revision for dislocation. Femoral heads ≥ 40 mm without TS had a higher all-cause revision rate than 36 mm heads without TS (HR 1.28, 95% CI 1.07 to 1.54, P < 0.008), driven by increased rates of revision for infection, dislocation, wear, and mechanical complications. There was no difference in all-cause revision between ≥ 40-mm heads with TS and 36 mm heads without TS (HR 1.00, 95% CI 0.70 to 1.44, P = 0.991). Use of TS is associated with increased risk of revision with 36 mm ceramic heads. Compared to 36 mm heads, ≥ 40 mm heads without TS are associated with increased risk of revision, but there is no difference using ≥ 40 mm heads with TS. Risk of revision appears to be most influenced by head size. These findings should be considered when deciding on the use of TS in primary THA.