Dual-mobility constructs versus large femoral head bearings in primary and revision total hip arthroplasty: a systematic review and meta-analysis of comparative studies

Abstract

Background: Both dual-mobility (DM) constructs and large femoral head bearings (⩾36 mm) reduce dislocation following total hip arthroplasty (THA). There is limited research comparing DM with large bearings. Methods: A systematic review of published literature was performed including studies that compared DM with large femoral head bearings in primary or revision THA according to PRISMA guidelines. The primary outcome was revision surgery for dislocation. The secondary outcome was all-cause revision surgery. Other complications were recorded. 2 authors independently selected studies, performed data extraction, and risk of bias assessment. Treatment effects were assessed using odds ratios and data were pooled using a fixed-effect model, where appropriate. Results: 9 studies, all retrospective, met the final inclusion criteria. 2722 patients received DM and 9,789 large femoral head bearings. The difference in the odds of revision surgery for dislocation (OR 0.67; 95% CI, 0.45–1.01; p = 0.06) and aseptic loosening are unclear (OR 0.61; 95% CI, 0.36–1.05; p = 0.07); including important benefits and no difference. There was a benefit favouring DM for the risk of all-cause revision (OR 0.70; 95% CI, 0.56–0.86; p = 0.001), revision for fracture (OR 0.49; 95% CI, 0.29–0.81; p = 0.005) and dislocation not requiring revision (OR 0.29; 95% CI, 0.14–0.57; p < 0.001). The estimate in the difference in the odds of revision surgery for infection was imprecise (OR 0.78; 95% CI, 05.1–1.20; p = 0.26). Conclusions: This study provides evidence that there may be clinically relevant benefits of DM constructs over large femoral head bearings. Prospective randomised studies are warranted given these findings.

Unstable Total Hip Arthroplasty: Should It Be Revised Using Dual Mobility Implants? A Retrospective Analysis from the R.I.P.O. Registry

“…Sonn et al [ 37 ], in a retrospective study of 301 revision THAs divided according to the use of DMC implants or standard cups with a femoral head of ≥40 mm, found that there were no differences in dislocation rates between the implants. Moreover, Hoskins et al [ 38 ] in a meta-analysis compared primary and revision DMC constructs versus large femoral head bearings in primary and revision THAs; they found a clear advantage for the use of DMCs in primary implants, while in THA revisions, the difference in the risk of revision surgery for dislocation was unclear. They remarked that the topic lacked a literature with medium- to long-term follow-up.…”

Comparison of Premium Technology Utilization in Total Hip Arthroplasty Between Safety-net Hospitals and Non–safety-net Hospitals

“…17 The improved stability and range of motion may provide a better option for younger and active patients. 18,19 Nevertheless, SNH status was associated with decreased utilization of DM indicating unequal usage to this premium technology.…”

No dislocation and low complication rate for a modern dual mobility cup with pre-impacted femoral head in primary hip replacement: A consecutive series of 175 hips at minimum 5-year follow-up

“…The efficiency of dual mobility cups (DMC) in reducing dislocation is no longer to be proven. Since its introduction in France by Gilles Bousquet in 1974 [1], many studies have shown its efficiency in trauma, primary and revision surgeries [2][3][4][5][6][7]. These promising results were observed very soon in the original studies using first-generation DMC [8].…”