Dual-mobility constructs or large femoral head bearings in revision total hip arthroplasty?
Year: 2025
Type: article
Abstract: Purpose Dislocation remains a leading cause of failure following revision total hip arthroplasty (rTHA). Dual-mobility cups (DMCs) and large femoral heads (LFHs) have been employed to mitigate this risk, yet the comparative effectiveness remains debated. This systematic literature review aimed to compare dislocation, re-revision, and complication rates between DMC and LFH constructs in rTHA. Methods This review followed PRISMA guidelines. A systematic search of Scopus, PubMed, and Embase databases yielded 2970 records. After screening using Covidence and removal of duplicates, 35 full texts were reviewed, and 9 studies met the inclusion criteria. Studies included patients undergoing rTHA with either DMC or LFH constructs and reporting on dislocation, re-revision, or related complications. Relative risk (RR), absolute risk reduction (ARR), and number needed to treat (NNT) for outcomes of interest were calculated. Results Nine comparative studies encompassing 3095 rTHAs (1204 DMCs and 1891 LFHs ≥36 mm) met the inclusion criteria. Post-operative dislocation occurred in 17 of 437 DMC hips (3.9%) and 54 of 711 LFH hips (7.6%), yielding a RR of 0.51 (49% reduction when DMC is used) and an ARR of 3.7% (NNT 27). Re-revision for any cause was also lower with DMCs (6.3% vs. 9.2%; ARR 2.9%), driven mainly by fewer re-revisions for instability (3.1% vs. 6.2%; ARR 3.1%). Conclusions In rTHA, DMCs offer a potential reduction in dislocation and re-revision risk compared with LFHs, particularly in high-risk patients. While cost-effectiveness and survivorship analyses support DMC use, well-powered randomized controlled trials with long-term data are warranted.
Institution: Cleveland Clinic Florida
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,770
OpenAlex ID: W4417130127