Risk Factors and Modes for Implant Failure in the Modern Dual Mobility Implant. A Systematic Review and Meta-analysis
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.
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Figure S1. Forest plot of the pooled aseptic loosening rate among included studies.
Figure S1. Forest plot of the pooled aseptic loosening rate among included studies.
Figure S1. Forest plot of the pooled aseptic loosening rate among included studies.
Figure S2. Forest plot of the pooled septic loosening rate among included studies.
Figure S2. Forest plot of the pooled septic loosening rate among included studies.
Figure S2. Forest plot of the pooled septic loosening rate among included studies.
Figure S3. Forest plot of the pooled extra-articular dislocation rate among included studies.
Figure S3. Forest plot of the pooled extra-articular dislocation rate among included studies.
Figure S3. Forest plot of the pooled extra-articular dislocation rate among included studies.
Figure S4. Forest plot of the pooled intra-prosthetic dislocation rate among included studies.
Figure S4. Forest plot of the pooled intra-prosthetic dislocation rate among included studies.
Figure S4. Forest plot of the pooled intra-prosthetic dislocation rate among included studies.
Figure S5. Forest plot of the pooled periprosthetic fracture rate among included studies.
Figure S5. Forest plot of the pooled periprosthetic fracture rate among included studies.
Figure S5. Forest plot of the pooled periprosthetic fracture rate among included studies.
Figure S6. Forest plot of the pooled implant failure rate among included studies.
Figure S6. Forest plot of the pooled implant failure rate among included studies.
Figure S6. Forest plot of the pooled implant failure rate among included studies.
Figure S7. Forest plot of the pooled Harris hip score among included studies.
Figure S7. Forest plot of the pooled Harris hip score among included studies.
Figure S7. Forest plot of the pooled Harris hip score among included studies.
Figure S8. Forest plot of the pooled Merle d’Aubigné score among included studies.
Figure S8. Forest plot of the pooled Merle d’Aubigné score among included studies.
Figure S8. Forest plot of the pooled Merle d’Aubigné score among included studies.
Posted 25 Nov, 2020
Received 28 Dec, 2020
Received 28 Dec, 2020
Received 28 Dec, 2020
Received 28 Dec, 2020
Received 28 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
Invitations sent on 22 Nov, 2020
On 20 Nov, 2020
On 20 Nov, 2020
On 19 Nov, 2020
On 16 Nov, 2020
Risk Factors and Modes for Implant Failure in the Modern Dual Mobility Implant. A Systematic Review and Meta-analysis
Posted 25 Nov, 2020
Received 28 Dec, 2020
Received 28 Dec, 2020
Received 28 Dec, 2020
Received 28 Dec, 2020
Received 28 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
On 12 Dec, 2020
Invitations sent on 22 Nov, 2020
On 20 Nov, 2020
On 20 Nov, 2020
On 19 Nov, 2020
On 16 Nov, 2020
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