Modern Dual-Mobility Cups in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Levin, Jay M.; Sultan, Assem A.; O’Donnell, Jeffrey; Sodhi, Nipun; Khlopas, Anton; Piuzzi, Nicolás S.; Mont, Michael A.

doi:10.1016/j.arth.2018.08.013

Cited by 49 publications

(52 citation statements)

References 46 publications

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“… 13 A recent systematic review of revision THA using modern dual mobility bearings reported a dislocation rate of 2.2% at short-term follow-up, but only 1.2% needed re-revision, with the other 1% being stable after relocation. 14 …”

Section: Introductionmentioning

confidence: 99%

A cost-effectiveness assessment of dual-mobility bearings in revision hip arthroplasty

Khoshbin

Haddad

Ward

et al. 2020

The Bone & Joint Journal

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Aims The rate of dislocation when traditional single bearing implants are used in revision total hip arthroplasty (THA) has been reported to be between 8% and 10%. The use of dual mobility bearings can reduce this risk to between 0.5% and 2%. Dual mobility bearings are more expensive, and it is not clear if the additional clinical benefits constitute value for money for the payers. We aimed to estimate the cost-effectiveness of dual mobility compared with single bearings for patients undergoing revision THA. Methods We developed a Markov model to estimate the expected cost and benefits of dual mobility compared with single bearing implants in patients undergoing revision THA. The rates of revision and further revision were calculated from the National Joint Registry of England and Wales, while rates of transition from one health state to another were estimated from the literature, and the data were stratified by sex and age. Implant and healthcare costs were estimated from local procurement prices and national tariffs. Quality-adjusted life-years (QALYs) were calculated using published utility estimates for patients undergoing THA. Results At a minimum five-year follow-up, the use of dual mobility was cost-effective with an estimated incremental cost-effectiveness ratio (ICER) of between £3,006 and £18,745/QALY for patients aged < 55 years and between 64 and 75 years, respectively. For those aged > 75 years dual mobility was only cost-effective if the timeline was beyond seven years. The use of dual mobility bearings was cost-saving for patients aged < 75 years and cost-effective for those aged > 75 years if the time horizon was beyond ten years. Conclusion The use of dual mobility bearings is cost-effective compared with single bearings in patients undergoing revision THA. The younger the patient is, the more likely it is that a dual mobility bearing can be more cost-effective and even cost-saving. The results are affected by the time horizon and cost of bearings for those aged > 75 years. For patients aged > 75 years, the surgeon must decide whether the use of a dual mobility bearing is a viable economic and clinical option. Cite this article: Bone Joint J 2020;102-B(9):1128–1135.

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Section: Introductionmentioning

confidence: 99%

A cost-effectiveness assessment of dual-mobility bearings in revision hip arthroplasty

Khoshbin

Haddad

Ward

et al. 2020

The Bone & Joint Journal

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“…The unconstrained tripolar design of the DM implant enhances stability by effectively increasing the femoral head size while increasing the ROM to impingement and jump distance needed for dislocation. The long-term survivorship as well as rates of dislocation following rTHA with DM has been excellent [27], [33]. However, a fraction of high-risk patients will continue to experience dislocation despite these enhanced implant designs.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis by Levin et al. [27] reported a short- to mid-term dislocation rate of 2.2% following rTHA with the use of DM articulations. Early concerns over excessive early wear due to the additional bearing, aseptic loosening, and intraprosthetic dislocation (IPD) have been largely alleviated, with an aseptic survivorship rate of 97.7% and aseptic loosening and IPD rates at 0.3% and 0.7%, respectively [27].…”

Section: Introductionmentioning

confidence: 99%

Cementation of a monoblock dual mobility bearing in a newly implanted porous revision acetabular component in patients undergoing revision total hip arthroplasty

et al. 2019

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Background: The most common indications for revision total hip arthroplasty are instability/dislocation and mechanical loosening. Efforts to address this have included the use of dual mobility (DM) articulations. The aim of this study is to report on the use of cemented DM cups in complex acetabular revision total hip arthroplasty cases with a high risk of recurrent instability. Methods: A multicenter, retrospective study was conducted. Patients who received a novel acetabular construct consisting of a monoblock DM cup cemented into a fully porous metal shell were included. Outcome data included 90-day complications and readmissions, revision for any reason, and Harris Hip Scores. Results: Thirty-eight hips in 38 patients were included for this study. At a median follow-up of 215.5 days (range 6-783), the Harris Hip Score improved from a mean of 50 ± 12.2 to 78 ± 11.2 (P < .001). One (2.6%) patient experienced a dislocation on postoperative day 1, and was closed reduced with no further complications. There was 1 (2.6%) reoperation for periprosthetic joint infection treated with a 2-stage exchange. Conclusions: In this complex series of patients, cementation of a monoblock DM cup into a newly implanted fully porous revision shell reliably provided solid fixation with a low risk of dislocation at short-term follow-up. Although longer term follow-up is needed, utilization of this novel construct should be considered in patients at high risk for instability.

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“…However, exact acetabular component position that is ideally suited for each patient is unknown and may change over time [ [5] , [6] , [7] , [8] ]. As such, dual-mobility (DM) articulations, a construct which increases impingement-free range of motion by adding a second articulation and increasing the effective femoral head size and jump distance, have become attractive options for surgeons to mitigate the risk of hip instability [ [9] , [10] , [11] , [12] , [13] , [14] , [15] ].…”

Section: Introductionmentioning

confidence: 99%

“…Multiple systematic reviews and case series report reduced dislocation rates of DM constructs in high-risk patients undergoing primary and revision THA [ [10] , [11] , [12] , [13] ]. However, added modularity introduces additional potential complications, including modular liner malseating and/or dissociation and intraprosthetic dislocation (IPD) [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Modular Dual-Mobility Liner Malseating: A Radiographic Analysis

2020

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Background: With dislocation as a leading cause for revision after total hip arthroplasty (THA), modular dualmobility (MDM) constructs are more commonly used at present in an attempt to decrease postoperative instability. With modularity, there is potential for additional complications, including malseating of the liner. The goal of this study was to perform a radiographic analysis on the incidence of MDM liner malseating. Methods: We retrospectively identified 305 patients (305 THAs) who underwent primary THA with an MDM liner from a single manufacturer inserted by a single surgeon. One hundred fifty-six (51%) patients were male. The mean age was 68 years, and the mean body mass index was 31 kg/m 2. Only patients with both anteroposterior and cross-table lateral radiographs at a minimum of 6 weeks postoperatively were included. Dislocations and reoperations were determined at 1 year after the procedure. All MDM liners were routinely tested intraoperatively with a "4-quadrant test" to assess for proper seating. Results: Four (4/305, 1.3%) MDM liners were noted to be radiographically malseated at early follow-up with three (3/147, 2.0%) occurring in a thinner two dimentional (2D) ongrowth shell and only one (1/ 158, 0.6%) observed in a thicker three dimentional (3D) additively manufactured shell. They were inferiorly prominent by a median of 1.2 mm, best seen on the cross-table lateral radiograph. In patients with at least 1-year follow-up, no MDM liners dissociated and no patients sustained a dislocation. Five (1.6%) patients required reoperation unrelated to the acetabular or MDM construct. Conclusions: Surgeons should be aware that malseating of dual-mobility liners may occur. However, with utilization of a consistent surgical technique to test for seating of the liner, the radiographic incidence of MDM liner malseating was low at 1%. Although there were no short-term clinical implications of liner malseating, long-term follow-up is needed.

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Modern Dual-Mobility Cups in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Cited by 49 publications

References 46 publications

A cost-effectiveness assessment of dual-mobility bearings in revision hip arthroplasty

A cost-effectiveness assessment of dual-mobility bearings in revision hip arthroplasty

Cementation of a monoblock dual mobility bearing in a newly implanted porous revision acetabular component in patients undergoing revision total hip arthroplasty

Modular Dual-Mobility Liner Malseating: A Radiographic Analysis

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