Clinical Concerns With Dual Mobility- Should I Avoid it When Possible?

The utilization of dual mobility (DM) articulations in total hip arthroplasty (THA) is increasing. The principal appeal of DM implants is its ability to reduce postoperative instability by maximizing the effective ball head size for each reconstruction. However, while DM implants have been used worldwide for over 3 decades, the experience in North America is more limited. Moreover, there remains concerns with intraprosthetic dissociation, wear, metallosis, and soft tissue impingement. Therefore, the purpose of this article is to review the available evidence for these potential issues. First, intraprosthetic dissociation (IPD) is a unique complication of DM implants. Although the rate has decreased with improvements in materials and design, the reported prevalence is approximately 1%. Second, wear in DM implants can be unpredictable and increased wear has been reported in younger, active patients. Third, corrosion in modular DM implants has been described and elevations in serum cobalt and chromium levels have been reported. While the clinical significance of these elevations is unclear, it remains a source of concern with these implants. Finally, psoas impingement and entrapment can be a source of persistent groin pain after THA. DM articulations are a valuable addition to the armamentarium of total hip surgeons. However, these bearings are not free of complications. Consequently, current data only support selective use of DM bearings in patients at increased risk for postoperative instability after arthroplasty.