Modern Dual-Mobility Cups in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Background: The purpose of this systematic review is to analyze the outcomes of dual-mobility (DM) cups in revision total hip arthroplasty (THA). Specifically, we evaluated the following: (1) all-cause and aseptic survivorship rates; (2) dislocation rates; (3) complications; and (4) clinical outcomes reported using validated health status measures. Methods: A comprehensive literature search included studies that reported the following: (1) re-revision rates, (2) complications, and (3) clinical outcomes following DM use in revision THA. The following exclusion criteria were used: (1) studies that did not stratify their analysis between primary and revision THA, (2) studies that utilized off-label techniques, (3) review articles, (4) case studies, (5) basic science articles, (6) noneEnglish language reports, and (6) reports on patients who underwent surgery before 2010, in order to reflect modern DM implants use and technology. A total of 9 studies were included in our final analysis. Results: Aseptic and all-cause survivorship rates were 97.7% and 94.5%. Prevalence of dislocation was 2.2%, and 0.3% for intraprosthetic dislocation. Meta-analysis comparing DM to fixed-bearing prostheses demonstrated a significantly lower odds of dislocation in the DM cohort (odds ratio 0.24, P = .002). Complications occurred in 7.4% of revision THAs with DM cups, while infection rates totaled to 3.3% of cases. Studies comparing outcomes using Harris Hip Scores did not demonstrate a statistically significant difference in improved postoperative scores (P >.05). Conclusion: DM cups have demonstrated excellent survivorship, low dislocation, and overall complication rates. Therefore, it can be considered a safe and effective option, particularly in the high-risk patients who undergo revision THA. (C) 2018 Elsevier Inc. All rights reserved.