Abstract：
BACKGROUND: Dual mobility (DM) implants have received increasing interest in revision surgery due to their increased stability. The aim of this systematic review was to compare outcomes of DM versus conventional fixed-bearing (FB) implants in revision total hip arthroplasty (rTHA).
METHODS: A comprehensive search was performed using the PubMed, Embase, and MEDLINE databases between January 2000 and 2023. Outcome measures included rerevision due to dislocation, rerevision for other causes, all-cause rerevision, total complication rate, and functional outcome measures. The Methodological Index for Nonrandomized Studies assessment tool was used to evaluate methodological quality and the risk of bias. A pooled meta-analysis was conducted, with an assessment of heterogeneity using the Chi-square and Higgins I2 tests. A further subgroup analysis was performed between DM implants and larger femoral head (> 36 mm) FB implants.
RESULTS: A total of 13 studies met the final inclusion criteria, with an overall number of 5,004 rTHA hips included (2,108 DM and 2,896 FB). The DM implants had significantly lower odds of rerevision due to dislocation (odds ratio [OR] 0.38, P < 0.001), aseptic loosening (OR 0.54, P = 0.004), and all-cause rerevision (OR 0.55, P < 0.001) compared to FB implants. No statistically significant difference was seen in the odds of rerevision due to periprosthetic joint infection (OR 0.99, P = 0.94) or periprosthetic fracture (OR 0.59, P = 0.13) between the 2 groups. The total number of complications showed an odds benefit in favor of DM implants (OR 0.43, P < 0.001). In the subgroup analysis, there was no significant difference in the odds of rerevision due to dislocation (OR 0.69, P = 0.11) between DM and larger femoral head FB implants.
CONCLUSIONS: Based on current literature, it appears DM implants are an effective modality for reducing dislocation following rTHA with lower complication rates compared to FB implants. However, further prospective randomized controlled trials with longer term follow-up are required.
METHODS: A comprehensive search was performed using the PubMed, Embase, and MEDLINE databases between January 2000 and 2023. Outcome measures included rerevision due to dislocation, rerevision for other causes, all-cause rerevision, total complication rate, and functional outcome measures. The Methodological Index for Nonrandomized Studies assessment tool was used to evaluate methodological quality and the risk of bias. A pooled meta-analysis was conducted, with an assessment of heterogeneity using the Chi-square and Higgins I2 tests. A further subgroup analysis was performed between DM implants and larger femoral head (> 36 mm) FB implants.
RESULTS: A total of 13 studies met the final inclusion criteria, with an overall number of 5,004 rTHA hips included (2,108 DM and 2,896 FB). The DM implants had significantly lower odds of rerevision due to dislocation (odds ratio [OR] 0.38, P < 0.001), aseptic loosening (OR 0.54, P = 0.004), and all-cause rerevision (OR 0.55, P < 0.001) compared to FB implants. No statistically significant difference was seen in the odds of rerevision due to periprosthetic joint infection (OR 0.99, P = 0.94) or periprosthetic fracture (OR 0.59, P = 0.13) between the 2 groups. The total number of complications showed an odds benefit in favor of DM implants (OR 0.43, P < 0.001). In the subgroup analysis, there was no significant difference in the odds of rerevision due to dislocation (OR 0.69, P = 0.11) between DM and larger femoral head FB implants.
CONCLUSIONS: Based on current literature, it appears DM implants are an effective modality for reducing dislocation following rTHA with lower complication rates compared to FB implants. However, further prospective randomized controlled trials with longer term follow-up are required.
摘要：
目的：双移动性（DM）植入物由于其增加的稳定性，对翻修手术越来越感兴趣。这项系统评价的目的是比较DM与常规固定轴承（FB）植入物在翻修全髋关节置换术（r-THA）中的结果。
方法：使用PubMed进行了全面搜索，Embase,2000年1月至2023年之间的MEDLINE数据库。成果措施包括因错位而重新修订，为其他原因重新修订，所有原因的重新修订，总并发症发生率,和功能结果衡量标准。非随机研究方法学指数（MINORS）评估工具用于评估方法学质量和偏倚风险。进行了汇总荟萃分析，使用卡方和希金斯I2检验评估异质性。在DM植入物和较大的股骨头(>36mm)FB植入物之间进行进一步的亚组分析。
结果：共有13项研究符合最终纳入标准，包括5,004例r-THA臀部（2,108DM和2,896FB）。DM植入物由于脱位而重新翻修的几率明显降低（OR[比值比]0.38，P<0.001），无菌性松动（OR0.54，P=0.004），与FB植入物相比，所有原因的重新修订（OR0.55，P<0.001）。两组患者因假体周围感染（PJI）（OR0.99，P=0.94）或假体周围骨折（OR0.59，P=0.13）而重新翻修的几率差异无统计学意义。并发症总数显示出有利于DM植入物的优势（OR0.43，P<0.001）。在亚组分析中，DM和较大的股骨头FB植入物之间由于脱位而重新翻修的几率没有显着差异（OR0.69，P=0.11）。
结论：根据现有文献，与FB植入物相比，DM植入物似乎是减少r-THA后脱位的有效方法，并发症发生率较低。然而,需要进一步的前瞻性随机对照试验(RCTs)和长期随访.
方法：使用PubMed进行了全面搜索，Embase,2000年1月至2023年之间的MEDLINE数据库。成果措施包括因错位而重新修订，为其他原因重新修订，所有原因的重新修订，总并发症发生率,和功能结果衡量标准。非随机研究方法学指数（MINORS）评估工具用于评估方法学质量和偏倚风险。进行了汇总荟萃分析，使用卡方和希金斯I2检验评估异质性。在DM植入物和较大的股骨头(>36mm)FB植入物之间进行进一步的亚组分析。
结果：共有13项研究符合最终纳入标准，包括5,004例r-THA臀部（2,108DM和2,896FB）。DM植入物由于脱位而重新翻修的几率明显降低（OR[比值比]0.38，P<0.001），无菌性松动（OR0.54，P=0.004），与FB植入物相比，所有原因的重新修订（OR0.55，P<0.001）。两组患者因假体周围感染（PJI）（OR0.99，P=0.94）或假体周围骨折（OR0.59，P=0.13）而重新翻修的几率差异无统计学意义。并发症总数显示出有利于DM植入物的优势（OR0.43，P<0.001）。在亚组分析中，DM和较大的股骨头FB植入物之间由于脱位而重新翻修的几率没有显着差异（OR0.69，P=0.11）。
结论：根据现有文献，与FB植入物相比，DM植入物似乎是减少r-THA后脱位的有效方法，并发症发生率较低。然而,需要进一步的前瞻性随机对照试验(RCTs)和长期随访.
