Risk of revision and dislocation in single, dual mobility and large femoral head total hip arthroplasty: systematic review and network meta-analysis

Abstract

Postoperative dislocation is a challenging complication after total hip arthroplasty (THA) that affects patient outcome worldwide. Instability is one of the main complications with rates exceeding 20% in some series. Currently, alternative acetabular components are available with dual mobility (DMTHA) bearing surfaces and larger femoral head size that may reduce the risk of dislocation, yet provide the functional benefit of standard single mobility (STHA) bearing surface THA. However, whether STHA, big femoral head (BTHA) and DMTHA should be used is still controversial. This systematic review and meta-analysis aim to compare postoperative dislocation and revision (aseptic loosening and infection) of BTHA, STHA and DMTHA in primary or revision THA. These clinical outcomes consist of postoperative dislocation and revision (aseptic loosening and infection). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified from Medline and Scopus from inception to June 8, 2017, that reported postoperative dislocation and revision (aseptic loosening and infection) of either implant THA. Eleven of 677 studies (nine comparative studies and two RCTs) (N = 4084 patients) were eligible; all 11 studies were included in pooling. Intervention included dual mobility THA (N = 1068 patients), standard THA (N = 2568 patients), big head THA (N = 378 patients) and constrain THA (N = 70 patients). A network meta-analysis showed that risk of revision and dislocation of DMTHA was significantly lower with RR of 2.19 (1.36, 3.53) and 4.19 (2.04, 8.62) when compared to STHA. While there was no statistically significant risk of having revision and dislocation of DMTHA when compared to BTHA and CTHA. The SUCRA probability of DM and BTHA was in the first and second rank with 46.5 and 44.8% in the risk of revision and 46.7 and 45.1% in the risk of dislocations. In short-term outcomes (5 years or less, with follow-up of 0-5 years), the best implant of choice that has lowest risk of revision and dislocation after THA is DMTHA follow by BTHA. We recommend using dual mobility and big head as an implant for safety in THA. However, there were only two studies that reported long-term survivorship (more than 5 years, with follow-up of 5-15 years). Further research that assesses long-term survivorship is necessary to further evaluate which implants are the best for THA.

Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies

“…THA can effectively relieve pain symptoms and improve the quality of life of patients with hip disease. THA can be performed using a variety of surgical approaches, such as the direct anterior approach (DAA), the anterolateral approach, the lateral approach, and the posterolateral approach (PA) [4][5][6][7][8][9][10] . PA is commonly used because it is relatively simple to operate and is conducive to intraoperative exposure.…”

Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements

“…The pooled RR (95% CIs) for dislocation in two studies comparing BMI ≥35 vs <35 kg/m 2 A number of previous reviews have attempted to investigate potential risk factors for dislocation in THR, but these have either been based on single or selected risk factors, revision THR, a mixture of both primary and revision THR or were summarised using a narrative approach. [20][21][22][23]25,30,31 Haverkamp and colleagues in their review sought to evaluate the influence of obesity; in pooled analysis of 10 out of 15 studies, they demonstrated obesity (BMI >30 vs <30 kg/m 2 ) to be associated with an increased risk of dislocation. 22 In pooled analysis of 14 studies (of which 12 estimates were actually pooled), Jia and colleagues compared dislocation risk between direct anterior and posterior surgical approaches and reported no statistical significant difference in risk and their estimate was imprecise because of the low event rate.…”

“…31 Consistent with our findings of reduced risk of dislocations with dual mobility bearing surfaces (compared with standard bearings) and larger femoral head sizes, a recently published network meta-analysis demonstrated similar findings but was based on primary or revision THRs. 30 To our knowledge, our review represents the first attempt at evaluating and synthesising evidence on the relationships of patient-, surgery-, implant-and hospital-related factors with dislocation risk in one single investigation and in more detail than ever before using a systematic meta-analytic approach.…”

Dual Mobility Acetabular - Cup Total Hip Arthroplasty after Femoral Neck Fracture in the Elderly: Prospective Study on Risks of Early Dislocation in 80 Total Hip Replacements

“…Generally, as rule of thumb the use of large diameter femoral head could address the problem of instability and mechanical studies have exhibited low dislocation rates with 28 mm femoral head components [13][14][15].This concept does not exhibit complications pertaining to simple implant retention, which solicits attachment through bony press fit, with less wear as the larger joint allowed additional range of motion during dislocation manoeuvers. Pituckanotai, et al, [16] in a recent network meta-analysis recommend dual mobility and big head as safer implants in THA with less risk of dislocation and revision.…”