Update 

This article was updated on August 17, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1462, in the first sentence of the Abstract section entitled “Results,” the phrase that had read “and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003), but more dislocations than 32-mm heads (HR for >2 weeks = 2.25 [95% CI, 1.13 to 4.49]; p = 0.021)” now reads “and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003) and 32-mm heads (HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88]; p = 0.021).” On page 1468, in the last sentence of the section entitled “Acetabular Components with a Diameter of <51 mm,” the phrase that had read “and HR for ≥2 weeks = 2.25 [95% CI, 1.13 to 4.49; p = 0.021]) (Fig. 3)” now reads “and HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88; p = 0.021]) (Fig. 3).” Finally, on page 1466, in the upper right corner of Figure 3, under “32mm vs 36mm,” the second line that had read “2Wks+: HR=2.25 (1.13, 4.49), p=0.021” now reads “2Wks+: HR=0.44 (0.22, 0.88), p= 0.021.”

Background: 

The acetabular component diameter can influence the choice of femoral head size in total hip arthroplasty (THA). We compared the rates of revision by femoral head size for different acetabular component sizes.

Methods: 

Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for patients undergoing primary THA for a diagnosis of osteoarthritis from September 1999 to December 2019. Acetabular components were stratified into quartiles by size: <51 mm, 51 to 53 mm, 54 to 55 mm, and 56 to 66 mm. Femoral head sizes of 28 mm, 32 mm, and 36 mm were compared for each cup size. The primary outcome was the cumulative percent revision (CPR) for all aseptic causes and for dislocation. The results were adjusted for age, sex, femoral fixation, femoral head material, year of surgery, and surgical approach and were stratified by femoral head material.

Results: 

For acetabular components of <51 mm, 32-mm (hazard ratio [HR] = 0.75 [95% confidence interval (CI), 0.57 to 0.97]; p = 0.031) and 36-mm femoral heads (HR = 0.58 [95% CI, 0.38 to 0.87]; p = 0.008) had a lower CPR for aseptic causes than 28-mm heads; and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003), and 32-mm heads (HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88]; p = 0.021). For 51 to 53-mm, 54 to 55-mm, and 56 to 66-mm-diameter acetabular components, there was no difference in the CPR for aseptic causes among head sizes. A femoral head size of 36 mm had fewer dislocations in the first 2 weeks than a 32-mm head for the 51 to 53-mm acetabular components (HR for <2 weeks = 3.79 [95% CI, 1.23 to 11.67]; p = 0.020) and for the entire period for 56 to 66-mm acetabular components (HR = 1.53 [95% CI, 1.05 to 2.23]; p = 0.028). The reasons for revision differed for each femoral head size. There was no difference in the CPR between metal and ceramic heads.

Conclusions: 

There is no clear advantage to any single head size except with acetabular components of <51 mm, in which 32-mm and 36-mm femoral heads had lower rates of aseptic revision. If stability is prioritized, 36-mm femoral heads may be indicated.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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28、32 和 36 毫米股骨头和不同尺寸的股骨头初次全髋关节置换术后翻修率和脱位的比较：对 188,591 例初次全髋关节置换术的分析

更新 

本文于2022年8月17日更新，由于之前的错误，是在文章的初步版本在线发布后发现的。在第 1462 页，标题为“结果”的摘要部分的第一句中，短语“和 36 毫米头的位错比 28 毫米少（HR = 0.33 [95% CI，0.16 至 0.68]；p = 0.003），但比 32-mm 头部的位错更多（> 2 周的 HR = 2.25 [95% CI，1.13 至 4.49]；p = 0.021）”现在读作“并且 36-mm 头部的位错少于 28-mm （HR = 0.33 [95% CI，0.16 到 0.68]；p = 0.003）和 32 毫米头部（≥2 周的 HR = 0.44 [95% CI，0.22 到 0.88]；p = 0.021）。在第 1468 页，在标题为“直径小于 51 毫米的髋臼组件”部分的最后一句中，短语“和 HR ≥2 周 = 2.25 [95% CI, 1.13 to 4.49; p = 0.021]）（图。3)”现在读作“和 ≥2 周的 HR = 0.44 [95% CI, 0.22 to 0.88; p = 0.021]）（图 3）。” 最后，在第 1466 页，在图 3 的右上角，“32mm 与 36mm”下，第二行显示“2Wks+: HR=2.25 (1.13, 4.49), p=0.021”现在显示为“2Wks+: HR =0.44 (0.22, 0.88), p= 0.021。”

背景： 

髋臼假体直径会影响全髋关节置换术（THA）中股骨头尺寸的选择。我们比较了不同髋臼部件尺寸的股骨头尺寸的翻修率。

方法： 

对 1999 年 9 月至 2019 年 12 月接受原发性全髋关节置换术以诊断骨关节炎的患者的数据进行了分析。根据大小将髋臼组件分为四分位数：<51 毫米、51 至 53 毫米、54 至 55毫米和 56 至 66 毫米。比较了 28 mm、32 mm 和 36 mm 的股骨头尺寸与每个罩杯尺寸。主要结果是所有无菌原因和脱位的累积翻修百分比 (CPR)。结果根据年龄、性别、股骨固定、股骨头材料、手术年份和手术方法进行了调整，并按股骨头材料分层。

结果： 

对于<51 mm、32 mm（风险比 [HR] = 0.75 [95% CI，0.57 至 0.97]；p = 0.031）和 36 mm 股骨头（HR = 0.58 [95% CI，0.38 至 0.87]；p = 0.008) 无菌原因的 CPR 低于 28 毫米头部；和 36 毫米头比 28 毫米（HR = 0.33 [95% CI，0.16 至 0.68]；p = 0.003）和 32 毫米头（≥2 周的 HR = 0.44 [95% CI，0.22至 0.88]；p = 0.021)。对于 51 至 53 毫米、54 至 55 毫米和 56 至 66 毫米直径的髋臼部件，不同头型的无菌原因的 CPR 没有差异。对于 51 至 53 毫米的髋臼部件，36 毫米的股骨头在前 2 周比 32 毫米的股骨头脱位更少（<2 周的 HR = 3.79 [95% CI，1.23 至 11.67]；p = 0.020) 和 56 至 66 mm 髋臼假体的整个期间 (HR = 1.53 [95% CI, 1. 05至2.23]；p = 0.028）。每个股骨头尺寸的翻修原因不同。金属头和陶瓷头之间的 CPR 没有差异。

结论： 

除了髋臼组件 <51 mm 外，任何单一尺寸的股骨头都没有明显优势，其中 32 mm 和 36 mm 股骨头的无菌翻修率较低。如果优先考虑稳定性，则可能需要 36 毫米股骨头。

证据等级： 

治疗三级。有关证据级别的完整描述，请参见作者说明。