Can dual mobility cups prevent dislocation without increasing revision rates in primary total hip arthroplasty? A systematic review

Abstract

Background: Dislocation is one of the leading causes for early revision surgery after total hip arthroplasty (THA). To address this problem, the dual mobility (DM) cup was developed in the 1970s by the French. Despite the increased and, in some countries, broad use of DM cups, high quality evidence of their effectiveness compared to traditional unipolar (UP) cups is lacking. There are a few well-conducted literature reviews, but the level of evidence of the included studies was moderate to low and the rates of revision were not specifically investigated. Therefore, we did a systematic review to investigate whether there is a difference in the rate of dislocations and revisions after primary THA with a DM cup or a UP cup. Methods: We conducted a systematic literature search in PubMed, Embase and Cochrane databases in July 2019. The articles were selected based upon their quality, relevance and measurement of the predictive factor. We used the MINORS criteria to determine the methodological quality of all studies. Results: The initial search resulted in 702 citations. After application of the inclusion and exclusion criteria, eight articles met our eligibility criteria and were graded. Included studies were of medium to low methodological quality with a mean score of 14/24 (11-16) points following the MINORS criteria. In the case-control studies, a total of 549 DM cups and 649 UP cups were included. In the registry studies, a total of 5.935 DM cups and 217.362 UP cups were included. In the case-control studies, one (0.2%) dislocation was reported for the DM cups and 46 (7.1%) for the UP cup (p = 0.009, IQR = 0.00-7.00). Nine (1.6%) revisions, of which zero due to dislocation, were reported for the DM cup and 39 (6.0%), of which 30 due to dislocation, for the UP cup (p = 0.046, CI = −16.93-5.73). In the registry studies 161 (2.7%) revisions were reported for the DM cup, of which 14 (8.7%) due to dislocation. For the UP cup, 3.332 (1.5%) revisions were reported (p = 0.275, IQR = 41.00-866.25), of which 1.093 (32.8%) due to dislocation (p = 0.050, . Conclusion:This review suggests lower rates of dislocation and lower rates of revision for dislocation in favor of the DM cups. Concluding, DM cups might be an effective solution to reduce dislocation in primary THA. To evaluate the efficacy of DM cups compared to UP cups, an economic evaluation alongside a randomized controlled trial is needed focusing on patient important endpoints. Level of evidence: III, systematic review of level III studies.

Total Hip Arthroplasty Using a Hemispherical Uncemented Dual-Mobility Cup Results in Satisfactory Clinical Outcomes and No Dislocations at 2 years

“…This study suggests that hemispherical DM cups could be as effective at preventing dislocations as other contemporary DM cups with protrusive cylindro-spherical rims [ 1 , 3 , 12 ]. Furthermore, the short-term data regarding the absence of intraprosthetic instabilities at either the liner-cup junction or at the liner-head junction indicate that both 22-mm and 28-mm heads are compatible with this cup design.…”

“…DM cups have gained considerable popularity recently as they grant adequate range of motion while preventing instabilities [ 1 , 2 ]. With no dislocations and satisfactory short-term clinical scores, this sizable cohort confirms that the novel hemispherical DM cup studied is effective at preventing dislocations, although longer term follow-up remains necessary to ascertain the longevity of clinical outcomes and radiographic stability [ 2 , 4 , 6 ].…”

“…Dislocation is a feared and burdensome complication after total hip arthroplasty (THA), reported in up to 7% of primary THAs [ 1 , 2 ]. Over the past decade, dual-mobility (DM) cups demonstrated their efficacy at reducing subluxations and dislocations, as they have greater “jump distance” and higher ratios of head-to-neck diameters [ 3 ].…”

Dual mobility acetabular construct with freedom constrained liner for treatment of recurrent dislocations after total hip arthroplasty: A case report and literature review

“…Post-THA dislocation is a challenging multifactorial complication with multiple treatment options [ 15 , 16 ]. One such option involves the use of dual-mobility bearings, which are known to improve stability in both primary and revision THA [ [17] , [18] , [19] ]. Terrier et al suggested that dual mobility implants provided the greatest ROM before the risk of impingement and had a lower risk of subluxation and dislocation than standard and constrained implants in finite element analysis [ 20 ].…”

Dual mobility cups for total hip arthroplasty: tips and tricks

“…This has allowed the DMC concept to spread beyond France and to become international. Several recent publications reflect the surgical community's growing interest in this implant [6,7].…”