Background: Revision hip arthroplasty is associated with a dislocation rate that is three to five times greater than the rate following primary hip replacement. Conversion of a hip hemiarthroplasty to a total hip replacement is a revision arthroplasty, but it differs from revisions of total hip arthroplasties because a native acetabulum is replaced and the subsequent prosthetic femoral head is smaller. It was our purpose to determine whether the risk of dislocation following conversion surgery is the same as or greater than that following revision total hip replacement.
Methods: From 1994 to 2005, eighty-nine hemiarthroplasties were converted to a total hip arthroplasty in seventy-seven patients, and the results were compared with those of 115 first-time revision total hip replacements following a primary total hip replacement in 111 patients. A retrospective chart review was performed, and radiographic measurements were obtained. The patient demographics were similar between the two groups. The percentages of patients who had undergone revision of only the acetabular component as compared with both components as well as the percentages of those who had received a modular femoral stem as compared with a nonmodular stem were also similar between the two groups.
Results: Postoperatively, the femoral head size and the positioning of the acetabular component were similar between the two groups. The acetabular components were significantly larger (p < 0.001) in the group in which a total hip arthroplasty had been revised because they required additional acetabular reaming for placement of a new component. There were significantly more dislocations after the conversion procedures (22%) than after the revisions of the total hip arthroplasties (10%) (p < 0.018). Within both groups, the size of the acetabular component, the intraoperative range of motion, and the positioning of the acetabular component were similar between the hips that dislocated and those that did not. However, smaller femoral head components were at greater risk for dislocation after conversion surgery than after revision of a total hip arthroplasty.
Conclusions: A substantial reduction of the size of the prosthetic femoral head is unique to conversion arthroplasty and appears to play a role in instability after the revision surgery. While the smallest heads dislocated in the conversion group, a larger femoral head did not ensure stability. The increased dislocation risk with conversion surgery requires emphasis on soft-tissue balance and avoidance of excessive downsizing of the femoral head in an attempt to maximize hip stability.
Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.