Les cupules à double mobilité réduisent-elles le taux de luxation sans augmenter les taux de révision en arthroplastie totale de hanche primaire ? Analyse systématique de la littérature

Abstract

BackgroundDislocation 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 1970's 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 rate of revision was 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 total hip arthroplasty THA with a DM cup or a UP cup. MethodsWe 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. ResultsThe 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 5935 DM cups and 217.362 UP cups were included. In the case-control studies, 1 (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 0 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, 3332 (1.5%) revisions were reported (p=0.275, IQR=41.00–866.25), of which 1093 (32.8%) due to dislocation (p=0.050, IQR=3.50–293.25). ConclusionThis review suggests lower rates of dislocation and revision for dislocation in favor of the DM cups. 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. Level of evidenceIII, systematic review of level III studies. Prospero registry numberCRD42018091921.