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Can dual mobility cups prevent dislocation without increasing revision rates in primary total hip arthroplasty? A systematic review - 25/04/20

Doi : 10.1016/j.otsr.2019.12.019 
Ragna C. Jonker a, , Loes W.A.H. van Beers b, Bart C.H. van der Wal a, H. Charles Vogely a, Sebastien Parratte c, René M. Castelein a, Rudolf W. Poolman b, d
a Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands 
b Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands 
c Department of Orthopedic Surgery and Traumatology, St. Marguerite Hospital Marseille, 270 Boulevard de Sainte-Marguerite, 13009 Marseille, France 
d Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands 

Corresponding author. Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.Department of Orthopaedic Surgery, University Medical Center UtrechtPO Box 85500GA Utrecht3508The Netherlands

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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, IQR=3.50–293.25).

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.

El texto completo de este artículo está disponible en PDF.

Keywords : Dual mobility, Unipolar, Total hip arthroplasty, Dislocation, Revision


Esquema


 Prospero registry number: CRD42018091921.


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Vol 106 - N° 3

P. 509-517 - mai 2020 Regresar al número
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