JOA - 2026-04-22 - Journal Article
Minimum Two-Year Survivorship of Large Femoral Heads with Titanium Sleeves in Primary Total Hip Arthroplasty: An Analysis from the American Joint Replacement Registry.
Marcel S, Chris C, Isabella Z, James H, Vishal H
Topics
Key Takeaway
In primary THA, 36-mm ceramic heads with titanium sleeves carry a 34% higher all-cause revision risk (HR 1.34) versus 36-mm heads without sleeves, while ≥40-mm heads with titanium sleeves show no difference in revision risk compared to 36-mm heads without sleeves.
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Summary
This AJRR registry analysis asked whether titanium sleeve (TS) use modifies revision risk by ceramic femoral head size in primary THA in patients ≥65 years. Cause-specific Cox models adjusting for age, sex, BMI, and Charlson Comorbidity Index showed 36-mm heads with TS had HR 1.34 for all-cause revision versus 36-mm heads without TS, driven by dislocation; ≥40-mm heads without TS had HR 1.28 versus 36-mm without TS, driven by dislocation, infection, wear, and mechanical failure. Notably, ≥40-mm heads with TS showed no significant revision risk difference versus 36-mm heads without TS (HR 1.00).
Key Limitation
Registry data lack trunnion taper geometry and stem alloy composition, preventing determination of whether the observed revision risk differences reflect sleeve-trunnion mismatch, corrosion, or head-size-driven instability patterns.
Original Abstract
INTRODUCTION
Ceramic femoral heads with titanium sleeves (TS) are used in revision total hip arthroplasty (rTHA) 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 rTHA based on ceramic head size.
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 at least 65 years old who had a minimum two-year follow-up was analyzed. The THAs were categorized as using less than or equal to 28 mm (millimeter), 32 mm, 36 mm, or greater than or equal to 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.
RESULTS
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 compared to 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 greater than or equal to 40-mm without TS had a higher all-cause revision rate compared to 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 greater than or equal to 40-mm heads with TS and 36-mm heads without TS (HR 1.00, 95% CI 0.70 to 1.44, P = 0.991).
CONCLUSION
Use of TS is associated with increased risk of revision with 36-mm ceramic heads. Compared to 36-mm heads, greater than or equal to 40-mm heads without TS are associated with increased risk of revision, but there is no difference using greater than or equal to 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.