Background:

Both dual-mobility (DM) constructs and large femoral head bearings (⩾36 mm) reduce dislocation following total hip arthroplasty (THA). There is limited research comparing DM with large bearings.

Methods:

A systematic review of published literature was performed including studies that compared DM with large femoral head bearings in primary or revision THA according to PRISMA guidelines. The primary outcome was revision surgery for dislocation. The secondary outcome was all-cause revision surgery. Other complications were recorded. 2 authors independently selected studies, performed data extraction, and risk of bias assessment. Treatment effects were assessed using odds ratios and data were pooled using a fixed-effect model, where appropriate.

Results:

9 studies, all retrospective, met the final inclusion criteria. 2722 patients received DM and 9,789 large femoral head bearings. The difference in the odds of revision surgery for dislocation (OR 0.67; 95% CI, 0.45–1.01; p = 0.06) and aseptic loosening are unclear (OR 0.61; 95% CI, 0.36–1.05; p = 0.07); including important benefits and no difference. There was a benefit favouring DM for the risk of all-cause revision (OR 0.70; 95% CI, 0.56–0.86; p = 0.001), revision for fracture (OR 0.49; 95% CI, 0.29–0.81; p = 0.005) and dislocation not requiring revision (OR 0.29; 95% CI, 0.14–0.57; p < 0.001). The estimate in the difference in the odds of revision surgery for infection was imprecise (OR 0.78; 95% CI, 05.1–1.20; p = 0.26).

Conclusions:

This study provides evidence that there may be clinically relevant benefits of DM constructs over large femoral head bearings. Prospective randomised studies are warranted given these findings.

中文翻译：

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双活动结构与大型股骨头轴承在初次和翻修全髋关节置换术中：比较研究的系统评价和荟萃分析

背景：

双活动性 (DM) 结构和大型股骨头轴承 (36 mm) 都可减少全髋关节置换术 (THA) 后的脱位。将 DM 与大型轴承进行比较的研究有限。

方法：

对已发表的文献进行了系统评价，包括根据 PRISMA 指南比较 DM 与大型股骨头轴承在初次或翻修 THA 中的研究。主要结果是脱位翻修手术。次要结果是全因翻修手术。记录其他并发症。2位作者独立选择研究，进行数据提取和偏倚风险评估。使用优势比评估治疗效果，并在适当时使用固定效应模型汇总数据。

结果：

9 项研究均为回顾性研究，符合最终纳入标准。2722 名患者接受了 DM 和 9,789 个大股骨头轴承。脱位翻修手术（OR 0.67；95% CI，0.45-1.01；p = 0.06）和无菌性松动的几率差异尚不清楚（OR 0.61；95% CI，0.36-1.05；p = 0.07）；包括重要的好处并没有区别。DM 对全因翻修（OR 0.70；95% CI，0.56-0.86；p = 0.001）、骨折翻修（OR 0.49；95% CI，0.29-0.81；p = 0.005）的风险有利脱位不需要翻修（OR 0.29；95% CI，0.14–0.57；p <0.001)。对感染翻修手术几率差异的估计是不精确的（OR 0.78；95% CI，05.1-1.20；p = 0.26）。

结论：

这项研究提供的证据表明，DM 结构可能比大型股骨头轴承具有临床相关益处。鉴于这些发现，有必要进行前瞻性随机研究。