The efficacy of dual-mobility cup in preventing dislocation after total hip arthroplasty: a systematic review and meta-analysis of comparative studies
- 436 Downloads
Although long-term reports of total hip arthroplasty (THA) showed successful results, instability remains a major complication. Recently, dual-mobility cups (DMC) have gained more and more interest among clinicians, with encouraging results in terms of lower rate of dislocation associated with good clinical results, but a lack of evidence exists regarding the real efficacy of this implant design compared to traditional fixed-bearing total hip arthroplasties.
A systematic search was performed in PubMed, Google scholar, Cochrane Library, and EMBASE by two independent reviewers for comparative studies available till December 2017, with the primary objective to demonstrate a real lower dislocation rate of DMC implants compared to unipolar fixed-bearing cup designs. A meta-analysis was conducted with the collected pooled data about dislocation rate, calculating the risk difference (RD) and relative risk (RR) with 95% CI for dichotomous variables. Heterogeneity was tested using the χ2 and Higgins’ I2 tests. A fixed-effect model was used because the statistical heterogeneity was below 50%.
After performing a critical exclusion process, the number of eligible studies included for final synthesis considered was 15, describing the results of a total of 2408 total hip arthroplasties (50.6% with a dual-mobility acetabular cup design, 49.4% with a standard fixed-bearing design). The fixed-effect meta-analysis showed a slight significant risk ratio of 0.16 (95% CI, 0.09, 0.28; I2 = 0%, p < 0.00001); a statistically significant difference in favor of the DMC group was maintained also considering only primary or revision arthroplasties, traumatic fractures or elective patients with diagnosis of osteoarthritis, avascular osteonecrosis or rheumatic arthritis.
With the intrinsic limitations of our study design and based on the current available data, this study demonstrates that dual-mobility acetabular components decrease the risk of post-operative instability also in high-risk patients, both in primary and revision hip arthroplasties. However, new high-quality studies, possibly with a randomized control design, should be undertaken in order to strengthen the present data.
Level of Evidence III, therapeutic study.
KeywordsDual-mobility cup Tripolar cup Dislocation Total hip arthroplasty
Compliance with ethical standards
Conflict of interest statement
Dr. Romagnoli M, Costa G.G., and other authors have nothing to disclose. Prof. Zaffagnini reports personal fees from DePuy, A Johnson & Johnson Company, and Smith & Nephew as speaker bureau, and from Springer, outside the submitted work.
- 4.Meek RMD, Allan DB, McPhillips G, Kerr L, Howie CR (2006) Epidemiology of dislocation after total hip arthroplasty. J Bone Joint Surg 447:9–18Google Scholar
- 5.Garellick G, Karrholm J, Rogmark C et al. (2001) Annual report. Swedish hip Arthroplasty register. (http://www.shpr.se/Libraries/Documents/%C3%85rsrapport_2011_eng_webb.sflb.ashx)
- 6.Australian Orthopaedic Association National Joint Replacement Registry (2015) Annual report. Adelaide: AOA; (https://www.aoa.org.au/docs/default-source/annualreports/annual-report-2012-2013.pdf?sfvrsn=6)
- 7.Annual report June 2010: the Norwegian Arthroplasty Register. [http://nrlweb.ihelse.net/eng/default.htm]
- 8.Torre M, Bellino S, Luzi I, Ceccarelli S, Salvatori G, Balducci MT, Piffer S, Zanoli G, Romanini E, Boniforti F, Carrani F (2016) Italian Register Arthroplasty Project. Third Report. Il Pensiero Scientifico Editore. Avaible via http://www.iss.it/binary/riap2/cont/3_Report_ RIAPcompleto_2016.pdf
- 10.Dargel J, Oppermann J, Brüggemann GP, Eysel P (2014) Dislocation following total hip replacement. Dtsch Arztebl Int 111(51–52):884–890Google Scholar
- 18.Orthopedic Network News. 2015 Hip and knee implant review. 2015. https://www.orthopedicnetworknews.com/archives/onn263s1.pdf. Accessed 2016 Oct 3
- 21.Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Molé D, Fessy MH, French Society of Orthopaedic Surgery and Traumatology SoFCOT (2012) Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Orthop Traumatol Surg Res 98:296–300CrossRefGoogle Scholar
- 22.Prudhon JL, Desmarchelier R, Hamadouche M, Delaunay C, Verdier R, SoFCOT (2017) Causes for revision of dual-mobility and standard primary total hip arthroplasty: matched case-control study based on a prospective multicenter study of two thousand and forty four implants. Int Orthop 41(3):455–459CrossRefGoogle Scholar
- 27.Hailer NP, Weiss RJ, Stark A, Kärrholm J (2012) The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish hip arthroplasty register. Acta Orthop 83(5):442–448CrossRefGoogle Scholar
- 30.Higgins JP, Green S, eds. Cochrane handbook for systematic reviews of interventions. Version 5.1.0.The Cochrane Collaboration. 2011. Available at http://www.cochrane-handbook.org. Accessed November 11, 2016
- 32.Parvizi J, Picinic E, Sharkey PF (2008) Revision total hip arthroplasty for instability: surgical techniques and principles. J Bone Joint Surg Am 90(5):1134–1142Google Scholar
- 37.Caton JH, Prudhon JL, Ferreira A, Aslanian T, Verdier R (2014) A comparative and retrospective study of three hundred and twenty primary Charnley type hip replacements with a minimum follow up of ten years to assess whether a dual mobility cup has a decreased dislocation risk. Int Orthop 38(6):1125–1129CrossRefGoogle Scholar
- 42.Griffin XL, Parsons N, Achten J, Costa ML (2016) A randomized feasibility study comparing total hip arthroplasty with and without dual mobility acetabular component in the treatment of displaced intracapsular fractures of the proximal femur: the Warwick hip trauma evaluation two: WHiTE two. Bone Joint J 98-B(11):1431–1435CrossRefGoogle Scholar
- 43.Hernigou P, Trousselier M, Roubineau F, Bouthors C, Flouzat Lachaniette CH (2016) Dual-mobility or constrained liners are more effective than preoperative bariatric surgery in prevention of THA dislocation. Clin Orthop Relat Res 474(10):2202–2210Google Scholar
- 47.Perrin A, Saab M, Putman S, Benad K, Drumez E, Chantelot C (2017) The benefit of the systematic revision of the acetabular implant in favor of a dual mobility articulation during the treatment of periprosthetic fractures of the femur: a 49 cases prospective comparative study. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/s00590-017-2037-2
- 51.Bousquet G, Gazielly DF, Debiesse JL (1985) The ceramic coated cementless total hip arthroplasty. Basic concepts and surgical technique. J Orthop Surg Tech 1:15–28Google Scholar
- 52.Howie DW, Holubowycz OT, Middleton R (2012) Large Articulation Study Group. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg [Am] 94-A:1095–1102Google Scholar
- 53.Malik A, Maheshawari A, Dorr LD (2007) Impingement with total hip replacement. J Bone Joint Surg Am 89:1832–1842Google Scholar