Dual Mobility Head in Total Hip Replacement for Instability: A Systematic Review
Author(s): Mohammed Alharbi*
Instability after complete hip arthroplasty (THA) is a common and worrisome problem which necessitates a comprehensive assessment and preoperative preparation prior to surgery. The management of an unstable THA is difficult even for an accomplished joints surgeon, so prevention by optimal index surgery is critical. Consequently, a potential option in total hip arthroplasty (THA) has been the dual mobility (DM) cups. Literature search was carried out using PubMed, Medline, Embase, Scopus and Cochrane Library for the studies existing till February 2021. Search was conducted by two independent reviewers separately keeping in view the structured format of the review. Data was thoroughly read through and were extracted manually on to a structured data extraction form. A total of 352 studies were identified through literature search, after removing duplicates. 71 articles were screened by two independent reviewers. A total of 18 studies were included in the final qualitative synthesis. Among these 18 studies, 9 studies were designed as prospective comparative studies while 9 studies were retrospective comparative studies. A total of 2859 total THAs (Total hip arthoplasties) with DMC (dual-mobility acetabular cup design) were studied. Sample size from all the studies collectively ranged from 16 to 653 in the DMC treated groups with patients mean age ranging from 48.5 years to 78 years which illustrated that all these studies predominantly included elderly population. The rate of dislocation in DMC treated cohorts varied between 0% and 3.8%. No case of dislocation was observed in 6 included studies. The dislocation rate risk ratio in primary THA cases, were observed to have significantly low risk of revision. According to the available data, this systematic analysis supports the usefulness of dual-mobility cup implants in minimizing postoperative dislocations and instability in patients undergoing total hip arthoplasties.