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Research Article
Risk Factors and Modes for Implant Failure in the Modern Dual Mobility Implant. A Systematic Review and Meta-analysis
Cheng-Fong Chen
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taiwan
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The aims of this meta-analysis were to: (1) validate the outcome of modern dual mobility (DM) designs in patients who had undergone primary and revision total hip arthroplasty (THA) procedures and (2) to identify factors that affect the outcome.
Methods
We searched for studies that assessed the outcome of modern DM-THA in primary and revision procedures that have been conducted between January, 2000 to August, 2020 on PubMed, MEDLINE, Cochrane Reviews and Embase. The pooled incidence of common failure modes and functional scores were evaluated in patients who have received: (1) primary THA, (2) revision THA for all causes or (3) for recurrent dislocation. A meta-regression analysis was performed for each parameter to determine the association with the outcome.
Results
A total of 120 studies (N= 30016 DM-THAs) were included for analysis. The mean follow-up duration was 47.3 months. The overall implant failure rate was 4.2% (primary: 2.3%, revision for all causes: 5.5%, recurrent dislocation: 6.0%). The most common failure modes were aseptic loosening (primary: 0.9%, revision for all causes: 2.2%, recurrent dislocation: 2.4%), septic loosening (primary:0.8%, revision for all causes: 2.3%, recurrent dislocation: 2.5%), extra-articular dislocation (primary:0.6%, revision for all causes:1.3%, recurrent dislocation:2.5%), intra-prosthetic dislocation (primary:0.8%, revision for all causes:1.0%, recurrent dislocation:1.6%) and periprosthetic fracture (primary:0.9%, revision for all causes:0.9%, recurrent dislocation:1.3%). The multi-regression analysis identified younger age (β=-0.04, 95% CI -0.07 – -0.02) and female patients (β=3.34, 95% CI 0.91–5.78) were correlated with higher implant failure rate. Age, gender, posterolateral approach and body mass index (BMI) were not risk factors for extra-articular or intra-prosthetic dislocation in this cohort. The overall Harris hip score and Merle d’Aubigné score were 84.87 and 16.36, respectively.
Conclusion
Modern dual-mobility designs provide satisfactory mid-term implant survival and clinical performance. Younger age and female patients might impact the outcome after DM-THA.
Keywords
Dislocation, dual mobility, implant failure, instability, outcome, revision total hip arthroplasty, risk factor, total hip arthroplasty
Figure 1
Figure 1
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
- 1027FigureS1asepticloosening.jpg
Figure S1. Forest plot of the pooled aseptic loosening rate among included studies.
- 1027FigureS1asepticloosening.jpg
Figure S1. Forest plot of the pooled aseptic loosening rate among included studies.
- 1027FigureS1asepticloosening.jpg
Figure S1. Forest plot of the pooled aseptic loosening rate among included studies.
- 1027FigureS2septicloosening.jpg
Figure S2. Forest plot of the pooled septic loosening rate among included studies.
- 1027FigureS2septicloosening.jpg
Figure S2. Forest plot of the pooled septic loosening rate among included studies.
- 1027FigureS2septicloosening.jpg
Figure S2. Forest plot of the pooled septic loosening rate among included studies.
- 1027FigureS3extradislocation.jpg
Figure S3. Forest plot of the pooled extra-articular dislocation rate among included studies.
- 1027FigureS3extradislocation.jpg
Figure S3. Forest plot of the pooled extra-articular dislocation rate among included studies.
- 1027FigureS3extradislocation.jpg
Figure S3. Forest plot of the pooled extra-articular dislocation rate among included studies.
- 1027FigureS4IPD.jpg
Figure S4. Forest plot of the pooled intra-prosthetic dislocation rate among included studies.
- 1027FigureS4IPD.jpg
Figure S4. Forest plot of the pooled intra-prosthetic dislocation rate among included studies.
- 1027FigureS4IPD.jpg
Figure S4. Forest plot of the pooled intra-prosthetic dislocation rate among included studies.
- 1027FigureS5Periprostheticfx.jpg
Figure S5. Forest plot of the pooled periprosthetic fracture rate among included studies.
- 1027FigureS5Periprostheticfx.jpg
Figure S5. Forest plot of the pooled periprosthetic fracture rate among included studies.
- 1027FigureS5Periprostheticfx.jpg
Figure S5. Forest plot of the pooled periprosthetic fracture rate among included studies.
- 1027FigureS6implantfailure.jpg
Figure S6. Forest plot of the pooled implant failure rate among included studies.
- 1027FigureS6implantfailure.jpg
Figure S6. Forest plot of the pooled implant failure rate among included studies.
- 1027FigureS6implantfailure.jpg
Figure S6. Forest plot of the pooled implant failure rate among included studies.
- 1027FigureS7HHS.jpg
Figure S7. Forest plot of the pooled Harris hip score among included studies.
- 1027FigureS7HHS.jpg
Figure S7. Forest plot of the pooled Harris hip score among included studies.
- 1027FigureS7HHS.jpg
Figure S7. Forest plot of the pooled Harris hip score among included studies.
- 1027FigureS8MerleDAubigne.jpg
Figure S8. Forest plot of the pooled Merle d’Aubigné score among included studies.
- 1027FigureS8MerleDAubigne.jpg
Figure S8. Forest plot of the pooled Merle d’Aubigné score among included studies.
- 1027FigureS8MerleDAubigne.jpg
Figure S8. Forest plot of the pooled Merle d’Aubigné score among included studies.
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Received 28 Dec, 2020
Review #1 received
Received 28 Dec, 2020
Reviewer #15 agreed
On 12 Dec, 2020
Reviewer #7 agreed
On 12 Dec, 2020
Reviewer #11 agreed
On 12 Dec, 2020
Reviewer #14 agreed
On 12 Dec, 2020
Reviewer #1 agreed
On 12 Dec, 2020
Reviewer #2 agreed
On 12 Dec, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Editor assigned
On 20 Nov, 2020
Editor invited
On 20 Nov, 2020
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On 19 Nov, 2020
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Risk Factors and Modes for Implant Failure in the Modern Dual Mobility Implant. A Systematic Review and Meta-analysis
Cheng-Fong Chen
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taiwan
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 25 Nov, 2020
No community comments so far
Review #14 received
Received 28 Dec, 2020
Review #6 received
Received 28 Dec, 2020
Review #10 received
Received 28 Dec, 2020
Review #13 received
Received 28 Dec, 2020
Review #1 received
Received 28 Dec, 2020
Reviewer #15 agreed
On 12 Dec, 2020
Reviewer #7 agreed
On 12 Dec, 2020
Reviewer #11 agreed
On 12 Dec, 2020
Reviewer #14 agreed
On 12 Dec, 2020
Reviewer #1 agreed
On 12 Dec, 2020
Reviewer #2 agreed
On 12 Dec, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Editor assigned
On 20 Nov, 2020
Editor invited
On 20 Nov, 2020
Submission checks complete
On 19 Nov, 2020
First submitted
On 16 Nov, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The aims of this meta-analysis were to: (1) validate the outcome of modern dual mobility (DM) designs in patients who had undergone primary and revision total hip arthroplasty (THA) procedures and (2) to identify factors that affect the outcome.
Methods
We searched for studies that assessed the outcome of modern DM-THA in primary and revision procedures that have been conducted between January, 2000 to August, 2020 on PubMed, MEDLINE, Cochrane Reviews and Embase. The pooled incidence of common failure modes and functional scores were evaluated in patients who have received: (1) primary THA, (2) revision THA for all causes or (3) for recurrent dislocation. A meta-regression analysis was performed for each parameter to determine the association with the outcome.
Results
A total of 120 studies (N= 30016 DM-THAs) were included for analysis. The mean follow-up duration was 47.3 months. The overall implant failure rate was 4.2% (primary: 2.3%, revision for all causes: 5.5%, recurrent dislocation: 6.0%). The most common failure modes were aseptic loosening (primary: 0.9%, revision for all causes: 2.2%, recurrent dislocation: 2.4%), septic loosening (primary:0.8%, revision for all causes: 2.3%, recurrent dislocation: 2.5%), extra-articular dislocation (primary:0.6%, revision for all causes:1.3%, recurrent dislocation:2.5%), intra-prosthetic dislocation (primary:0.8%, revision for all causes:1.0%, recurrent dislocation:1.6%) and periprosthetic fracture (primary:0.9%, revision for all causes:0.9%, recurrent dislocation:1.3%). The multi-regression analysis identified younger age (β=-0.04, 95% CI -0.07 – -0.02) and female patients (β=3.34, 95% CI 0.91–5.78) were correlated with higher implant failure rate. Age, gender, posterolateral approach and body mass index (BMI) were not risk factors for extra-articular or intra-prosthetic dislocation in this cohort. The overall Harris hip score and Merle d’Aubigné score were 84.87 and 16.36, respectively.
Conclusion
Modern dual-mobility designs provide satisfactory mid-term implant survival and clinical performance. Younger age and female patients might impact the outcome after DM-THA.
Figure 1
Figure 1
Figure 1