Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands.
Orthop Traumatol Surg Res. 2020 May;106(3):509-517. doi: 10.1016/j.otsr.2019.12.019. Epub 2020 Apr 8.
Dislocation is one of the leading causes for early revision surgery after total hip arthroplasty (THA). To address this problem, the dual mobility (DM) cup was developed in the 1970s by the French. Despite the increased and, in some countries, broad use of DM cups, high quality evidence of their effectiveness compared to traditional unipolar (UP) cups is lacking. There are a few well-conducted literature reviews, but the level of evidence of the included studies was moderate to low and the rates of revision were not specifically investigated. Therefore, we did a systematic review to investigate whether there is a difference in the rate of dislocations and revisions after primary THA with a DM cup or a UP cup.
We conducted a systematic literature search in PubMed, Embase and Cochrane databases in July 2019. The articles were selected based upon their quality, relevance and measurement of the predictive factor. We used the MINORS criteria to determine the methodological quality of all studies.
The initial search resulted in 702 citations. After application of the inclusion and exclusion criteria, eight articles met our eligibility criteria and were graded. Included studies were of medium to low methodological quality with a mean score of 14/24 (11-16) points following the MINORS criteria. In the case-control studies, a total of 549 DM cups and 649 UP cups were included. In the registry studies, a total of 5.935 DM cups and 217.362 UP cups were included. In the case-control studies, one (0.2%) dislocation was reported for the DM cups and 46 (7.1%) for the UP cup (p=0.009, IQR=0.00-7.00). Nine (1.6%) revisions, of which zero due to dislocation, were reported for the DM cup and 39 (6.0%), of which 30 due to dislocation, for the UP cup (p=0.046, CI=-16.93-5.73). In the registry studies 161 (2.7%) revisions were reported for the DM cup, of which 14 (8.7%) due to dislocation. For the UP cup, 3.332 (1.5%) revisions were reported (p=0.275, IQR=41.00-866.25), of which 1.093 (32.8%) due to dislocation (p=0.050, IQR=3.50-293.25).
This review suggests lower rates of dislocation and lower rates of revision for dislocation in favor of the DM cups. Concluding, DM cups might be an effective solution to reduce dislocation in primary THA. To evaluate the efficacy of DM cups compared to UP cups, an economic evaluation alongside a randomized controlled trial is needed focusing on patient important endpoints.
III, systematic review of level III studies.
脱位是全髋关节置换术后早期翻修手术的主要原因之一。为了解决这个问题，双动（DM）杯于 20 世纪 70 年代由法国人开发。尽管 DM 杯的使用有所增加，在某些国家甚至广泛使用，但与传统单极（UP）杯相比，其有效性的高质量证据仍然缺乏。有一些精心设计的文献综述，但纳入研究的证据水平为中等至低，并且没有专门调查翻修率。因此，我们进行了一项系统评价，以调查在初次全髋关节置换术中使用 DM 杯或 UP 杯是否存在脱位和翻修率的差异。
我们于 2019 年 7 月在 PubMed、Embase 和 Cochrane 数据库中进行了系统的文献检索。根据质量、相关性和预测因素的测量，对文章进行了选择。我们使用 MINORS 标准来确定所有研究的方法学质量。
最初的搜索产生了 702 条引文。在应用纳入和排除标准后，有 8 篇文章符合我们的纳入标准并进行了分级。纳入的研究方法学质量为中低水平，MINORS 标准平均得分为 14/24（11-16）分。在病例对照研究中，共纳入了 549 个 DM 杯和 649 个 UP 杯。在注册研究中，共纳入了 5935 个 DM 杯和 217362 个 UP 杯。在病例对照研究中，DM 杯报告了 1 例（0.2%）脱位，UP 杯报告了 46 例（7.1%）（p=0.009，IQR=0.00-7.00）。DM 杯报告了 9 例（1.6%）翻修，其中 0 例因脱位，UP 杯报告了 39 例（6.0%）翻修，其中 30 例因脱位（p=0.046，CI=-16.93-5.73）。在注册研究中，DM 杯报告了 161 例（2.7%）翻修，其中 14 例（8.7%）因脱位。对于 UP 杯，报告了 3332 例（1.5%）翻修（p=0.275，IQR=41.00-866.25），其中 1093 例（32.8%）因脱位（p=0.050，IQR=3.50-293.25）。
这项综述表明，DM 杯的脱位率和脱位翻修率较低，有利于 DM 杯。综上所述，DM 杯可能是减少初次全髋关节置换术脱位的有效方法。为了评估 DM 杯与 UP 杯相比的疗效，需要进行经济评价和随机对照试验，重点关注患者重要的终点。
III，III 级研究的系统评价。
