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Lim B, Chai A, Shaalan M. Comparison of Outcomes in Dual-Mobility Versus Fixed-Bearing Implants in Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e61715. [PMID: 38975513 PMCID: PMC11225095 DOI: 10.7759/cureus.61715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Total hip arthroplasty (THA) is often regarded as one of the most successful surgical techniques developed in the twenty-first century. However, it is associated with complications such as prosthetic instability, dislocations, or infections. Dual-mobility (DM) implants have been developed with the goal of reducing the incidence of dislocations by increasing the femoral head-neck ratio, maximising hip stability, and improving the range of motion (ROM) before impingement and dislocation. This systematic review aims to comprehensively compare the safety and efficacy of DM versus fixed-bearing (FB) implants in primary THA patients. A comprehensive search strategy of PubMed, Embase, Scopus, and Web of Science Core Collection databases was executed to identify pertinent literature comparing DM and FB implants in THAs. Eligible studies underwent independent screening, and data were systematically extracted. The analysis employed pooled risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous variables, each accompanied by their respective 95% confidence intervals (CI). Our systematic review and meta-analysis included nine studies encompassing 22,277 patients. The DM group had a significantly reduced incidence of dislocations compared to the FB group (RR 0.25, 95%CI [0.13, 0.47]; p-value <0.0001) and a significantly shorter length of stay (MD -9.92, 95%CI [-15.53, -4.32]; p-value = 0.0005). The FB group, however, had a significantly shorter operative time compared to the DM group (MD 10.41, 95%CI [7.64, 13.17]; p-value < 0.00001). We did not identify any significant statistical differences between the DM and FB groups regarding patient-reported outcome measures, the incidence of all-cause readmissions, the incidence of peri-prosthetic fractures, the incidence of infections, or the incidence of groyne pain.
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Affiliation(s)
- Brandon Lim
- School of Medicine, Trinity College Dublin, Dublin, IRL
| | - Ariel Chai
- School of Medicine, Trinity College Dublin, Dublin, IRL
| | - Mohamed Shaalan
- Orthopaedics and Traumatology, The Mater Misericordiae University Hospital, Dublin, IRL
- Trauma and Orthopaedics, St. James Hospital, Dublin, IRL
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Schaffler BC, Raymond HE, Black CS, Habibi AA, Ehlers M, Duncan ST, Schwarzkopf R. Two-Year Outcomes of Novel Dual-Mobility Implant in Primary Total Hip Arthroplasty. Adv Orthop 2024; 2024:4125965. [PMID: 38264013 PMCID: PMC10805547 DOI: 10.1155/2024/4125965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024] Open
Abstract
Introduction Dual-mobility (DM) implants for total hip arthroplasty (THA) have gained popularity due to their potential to reduce hip instability and dislocation events that may lead to revision surgery. These implants consist of a femoral head articulated within a polyethylene liner, which articulates within an outer acetabular shell, creating a dual-bearing surface. Our study aimed to report our observations on the survivorship of a novel DM implant for primary total hip arthroplasty at two years. Methods We conducted a retrospective, multicenter study to assess the clinical outcomes of patients undergoing a THA with a novel DM implant (OR3O acetabular system™, Smith & Nephew, Inc., Memphis, TN) from January 2020 to September 2021. Patient demographics, surgical information, and survivorship data were collected from medical records for patients with a minimum of two years of follow-up. Primary outcomes included overall implant survivorship at two years as well as aseptic survivorship, revision rates of the DM acetabular shell, and average time to revision. Patient-reported outcomes were collected in the form of HOOS JR. Results A total of 250 hips in 245 patients had a minimum two-year follow-up. Primary osteoarthritis (80%) was the most common indication for index THA. The average aseptic survivorship of the DM acetabular components at two years for the cohort was 98.4% and survivorship of the acetabular implants overall was 97.6%. There were a total of four (1.6%) aseptic revisions of the DM acetabular component. Reasons for aseptic acetabular revision included one case of instability, one intraprosthetic dislocation, one periprosthetic acetabular fracture, and one malpositioned acetabular cup resulting in impingement. The mean time of follow-up was 893.9 days. Eighty-seven patients had preoperative and two-year HOOS JR available. HOOS JR improved by an average of 38.5 points. Conclusion This novel DM acetabular implant demonstrates excellent survivorship at two years follow-up with low rates of instability and intraprosthetic dislocation and no episodes of metal-on-metal corrosion. Use of the DM implant demonstrated clinically relevant improvements in patient-reported outcomes at two years.
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Affiliation(s)
| | | | - Collin S. Black
- University of Kentucky, Department of Orthopaedic Surgery, Lexington, KY, USA
| | - Akram A. Habibi
- New York University Langone Orthopedic Hospital, New York, NY, USA
| | - Mallory Ehlers
- New York University Langone Orthopedic Hospital, New York, NY, USA
| | - Stephen T. Duncan
- University of Kentucky, Department of Orthopaedic Surgery, Lexington, KY, USA
| | - Ran Schwarzkopf
- New York University Langone Orthopedic Hospital, New York, NY, USA
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Ciriello V, La China R, Chirillo DF, Bianco G, Fusini F, Scarlato U, Albanese C, Bonzanini G, Banci L, Piovani L. Is Modular Dual Mobility Superior to Standard Bearings for Reducing Dislocation Risk after Primary Total Hip Arthroplasty? A Retrospective Comparative Multicenter Study. J Clin Med 2023; 12:4200. [PMID: 37445235 DOI: 10.3390/jcm12134200] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Dual mobility (DM) has been proven to reduce dislocation risk after total hip arthroplasty (THA). In the last decade modular DM (modDM) constructs have been introduced to allow the use of DM articulation with standard cementless acetabular shells. However, clinical evidence of modDM effectiveness is still low in primary THA and concerns about implant-related complications are increasing. This retrospective comparative multicenter study is aimed to investigate if the dislocation rate after primary THA could be reduced with modDM in comparison to standard bearing (SB). METHODS 262 THAs were performed between 2017 and 2019, using SB (129 hips) or modDM (133) with the same cementless highly porous modular acetabular cup. Dislocations, complications and revisions were recorded and implant survival was analyzed. RESULTS At 2.5-year mean follow-up, dislocation occurred in 4 hips (3.1%) within the SB group while intraprosthetic dislocation in 2 hips (1.5%) within the modDM group (p = 0.44). Implant survivals with revision due to dislocation were 95.2% and 95.9% at 4-year follow-up for SB and modDM, respectively (p = 0.50). CONCLUSIONS modDM used in primary THA might reduce dislocation rate in comparison to SB, even in high-risk patients, however, caution is advocated due to specific intraprosthetic dislocation.
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Affiliation(s)
- Vincenzo Ciriello
- Ortopedia e Traumatologia, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
| | - Roberta La China
- Ortopedia e Traumatologia, Ospedale Santo Spirito, 15033 Casale Monferrato, Italy
| | | | - Giuseppe Bianco
- Ortopedia e Traumatologia, Ospedale Regina Montis Regalis, 12084 Mondovì, Italy
| | - Federico Fusini
- Ortopedia e Traumatologia, Ospedale Regina Montis Regalis, 12084 Mondovì, Italy
| | - Ugo Scarlato
- Ortopedia e Traumatologia, Ospedale Civile, 10015 Ivrea, Italy
| | - Carlo Albanese
- Ortopedia e Traumatologia, Ospedale Civile, 10015 Ivrea, Italy
| | - Giancarlo Bonzanini
- Ortopedia e Traumatologia, Ospedale Sant'Antonio e Margherita, 15057 Tortona, Italy
| | - Lorenzo Banci
- Clinical Research Department, Permedica Orthopaedics, 23807 Merate, Italy
| | - Lucio Piovani
- Ortopedia e Traumatologia, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
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Simcox T, Singh V, Ayres E, Macaulay W, Schwarzkopf R, Aggarwal VK, Hepinstall MS. Selective Use of Dual-Mobility Did Not Significantly Reduce 90-Day Readmissions or Reoperations after Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00353-4. [PMID: 37068565 DOI: 10.1016/j.arth.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Selective use of dual mobility (DM) implants in total hip arthroplasty (THA) patients at high dislocation risk has been proposed. However, evidence-based utilization thresholds have not been defined. We explored whether surgeon-specific rates of DM utilization correlate with rates of readmission and reoperation for dislocation. METHODS We retrospectively reviewed 14,818 primary THA procedures performed at a single institution between 2011 and 2021, including 14,310 FB and 508 DM implant constructs. Outcomes including 90-day readmissions and reoperations were compared between patients who had fixed-bearing (FB) and DM implants. Cases were then stratified into three groups based on the attending surgeon's rate of DM utilization (≤1, 1 to 10, or >10%) and outcomes were compared. RESULTS There were no differences in 90-day outcomes between FB and DM implant groups. Surgeon frequency of DM utilization ranged from 0 to 43%. There were 48 surgeons (73%) who used DM in ≤ 1% of cases, 11 (17%) in 1 to 10% of cases, and 7 (10%) in >10% of cases. The 90-day rates of readmission (7.3 vs 7.6 vs 7.2%, P=0.7) and reoperation (3.4 vs 3.9 vs 3.8%, P=0.3), as well as readmission for instability (0.5 vs 0.6 vs 0.8%, P=0.2) and reoperation for instability (0.5 vs 0.5 vs 0.8%, P=0.6), did not statistically differ between cohorts. CONCLUSION Selective DM utilization did not reduce 90-day readmissions or reoperations following primary THA. Other dislocation-mitigation strategies (i.e., surgical approach, computer navigation, robotic assistance, and large diameter fixed-bearings) may have masked any benefits of selective DM use.
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Affiliation(s)
- Trevor Simcox
- Department of Orthopedic Surgery, NYU Langone Hospital - Long Island. 259 First Street, Mineola, NY, 11501
| | - Vivek Singh
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17(th) Street, New York, NY, 10010
| | - Ethan Ayres
- Department of Orthopedic Surgery, NYU Langone Hospital - Long Island. 259 First Street, Mineola, NY, 11501
| | - William Macaulay
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17(th) Street, New York, NY, 10010
| | - Ran Schwarzkopf
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17(th) Street, New York, NY, 10010
| | - Vinay K Aggarwal
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17(th) Street, New York, NY, 10010
| | - Matthew S Hepinstall
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17(th) Street, New York, NY, 10010.
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Butler JT, Stegelmann SD, Butler JL, Bullock M, M Miller R. Comparing dislocation rates by approach following elective primary dual mobility total hip arthroplasty: a systematic review. J Orthop Surg Res 2023; 18:226. [PMID: 36945061 PMCID: PMC10032016 DOI: 10.1186/s13018-023-03724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Dual mobility components can be implanted during total hip arthroplasty (THA) for primary osteoarthritis via a direct anterior approach (DAA), anterolateral approach (ALA), direct lateral approach (DLA), or posterior/posterolateral approach (PLA). This review compares dual mobility hip dislocation rates using these approaches for elective primary THA. METHODS PubMed, Embase, and Cochrane databases were systematically searched for articles published after January 1, 2006 that reported dislocation rates for adult patients after primary THA with dual mobility implants. Articles were excluded if they reported revision procedures, nonelective THA for femoral neck fractures, acetabular defects requiring supplemental implants, prior surgery, or ≤ 5 patients. The primary outcome was hip dislocation rate. Secondary outcomes included infection, Harris Hip Score (HHS), and Postel-Merle d'Aubigné (PMA) score. RESULTS After screening 542 articles, 63 met inclusion criteria. Due to study heterogeneity, we did not perform a meta-analysis. Eight studies reported DAA, 5 reported ALA, 6 reported the DLA, and 56 reported PLA. Study size ranged from 41 to 2,601 patients. Mean follow-up time ranged from 6 months to 25 years. Rates of infection and dislocation were low; 80% of ALA, 87.5% of DAA, 100% of DLA, and 82.1% of PLA studies reported zero postoperative dislocations. Studies reporting postoperative HHS and PMA scores showed considerable improvement for all approaches. CONCLUSIONS Patients undergoing primary THA with dual mobility implants rarely experience postoperative dislocation, regardless of surgical approach. Additional studies directly comparing DAA, ALA, DLA, and PLA are needed to confirm these findings.
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Affiliation(s)
- Justin T Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA.
| | - Samuel D Stegelmann
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Johnathon L Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Matthew Bullock
- Department of Orthopedic Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Richard M Miller
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
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