The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: a systematic review and meta-analysis of longitudinal observational studies

Richard L Donovan; Harvey Johnson; Sherwin Fernando; Michael Foxall-Smith; Michael R Whitehouse; Ashley W Blom; Setor K Kunutsor

doi:10.1016/j.arth.2022.01.017

The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: a systematic review and meta-analysis of longitudinal observational studies

Richard L Donovan^*, Harvey Johnson, Sherwin Fernando, Michael Foxall-Smith, Michael R Whitehouse, Ashley W Blom, Setor K Kunutsor

^*Corresponding author for this work

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

4 Citations (Scopus)

115 Downloads (Pure)

Abstract

Background
Dislocation after a primary total hip replacement (pTHR) remains a common cause of treatment failure. Constrained acetabular components (CACs) and dual mobility implants (DMIs) may mitigate this in patients at high risk of dislocation or with significant intra-operative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation following implantation with CACs and DMIs in pTHR.

Methods
Longitudinal studies reporting dislocation following the use of CACs or DMIs in pTHR were sought from MEDLINE and EMBASE to September 2020. Secondary outcomes included revision surgery for dislocation and all causes.

Results
46 studies (three CAC; 43 DMI) comprising 582 CACs and 18,748 DMIs were included. The pooled incidence of dislocation was 1.08% (95% CI:0.00,3.72) (range 0.27-2.60%) over a weighted mean follow-up of 4.1 years for CACs, compared with 0.25% (95% CI:0.08,0.46) (range 0.00-4.72%) over 6.2 years for DMIs. For DMIs, there was a temporal decline in dislocations from the 1980s onwards, and dislocation rates remained low (<1%) until 15 years post-operatively. There were insufficient data for similar analysis of CACs. All studies were at high risk of bias. The incidence of revision for dislocation after CACs was 0.3% versus 0.1% for DMIs, and the incidence of revision for all causes after CACs was 4.8% versus 2.7% for DMIs.

Conclusion
DMIs demonstrated a lower incidence of dislocation compared to CACs; however, there was a relative absence of CACs used in the context of pTHR in the literature. Temporal trends in dislocation have improved over time for DMIs.

Original language	English
Pages (from-to)	993-1001.e8
Journal	Journal of Arthroplasty
Volume	37
Issue number	5
Early online date	17 Jan 2022
DOIs	https://doi.org/10.1016/j.arth.2022.01.017
Publication status	E-pub ahead of print - 17 Jan 2022

Bibliographical note

Funding Information:
Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol for the submitted work. A.W.B. and M.R.W. disclose financial activities, outside the remit of the submitted work (A.W.B.: research grants; M.R.W.: research grants, lecturing, textbook royalties); no other relationships or activities that could appear to have influenced the submitted work.

Funding Information:
Funding: This study was supported by the NIHR Biomedical Research Center at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol ( BRC-1215-20011 ). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in considering the study design or in the collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the article for publication.

Publisher Copyright:
© 2022 Elsevier Inc.

Keywords

arthroplasty
replacement
hip
hip dislocation
contrained acetabular componant
dual mobility implant
systematic review
meta-analysis

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Donovan, R. L., Johnson, H., Fernando, S., Foxall-Smith, M., Whitehouse, M. R., Blom, A. W., & Kunutsor, S. K. (2022). The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: a systematic review and meta-analysis of longitudinal observational studies. Journal of Arthroplasty, 37(5), 993-1001.e8. Advance online publication. https://doi.org/10.1016/j.arth.2022.01.017

Donovan, Richard L ; Johnson, Harvey ; Fernando, Sherwin et al. / The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements : a systematic review and meta-analysis of longitudinal observational studies. In: Journal of Arthroplasty. 2022 ; Vol. 37, No. 5. pp. 993-1001.e8.

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title = "The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: a systematic review and meta-analysis of longitudinal observational studies",

abstract = "BackgroundDislocation after a primary total hip replacement (pTHR) remains a common cause of treatment failure. Constrained acetabular components (CACs) and dual mobility implants (DMIs) may mitigate this in patients at high risk of dislocation or with significant intra-operative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation following implantation with CACs and DMIs in pTHR.MethodsLongitudinal studies reporting dislocation following the use of CACs or DMIs in pTHR were sought from MEDLINE and EMBASE to September 2020. Secondary outcomes included revision surgery for dislocation and all causes.Results46 studies (three CAC; 43 DMI) comprising 582 CACs and 18,748 DMIs were included. The pooled incidence of dislocation was 1.08% (95% CI:0.00,3.72) (range 0.27-2.60%) over a weighted mean follow-up of 4.1 years for CACs, compared with 0.25% (95% CI:0.08,0.46) (range 0.00-4.72%) over 6.2 years for DMIs. For DMIs, there was a temporal decline in dislocations from the 1980s onwards, and dislocation rates remained low (<1%) until 15 years post-operatively. There were insufficient data for similar analysis of CACs. All studies were at high risk of bias. The incidence of revision for dislocation after CACs was 0.3% versus 0.1% for DMIs, and the incidence of revision for all causes after CACs was 4.8% versus 2.7% for DMIs.ConclusionDMIs demonstrated a lower incidence of dislocation compared to CACs; however, there was a relative absence of CACs used in the context of pTHR in the literature. Temporal trends in dislocation have improved over time for DMIs.",

keywords = "arthroplasty, replacement, hip, hip dislocation, contrained acetabular componant, dual mobility implant, systematic review, meta-analysis",

author = "Donovan, {Richard L} and Harvey Johnson and Sherwin Fernando and Michael Foxall-Smith and Whitehouse, {Michael R} and Blom, {Ashley W} and Kunutsor, {Setor K}",

note = "Funding Information: Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol for the submitted work. A.W.B. and M.R.W. disclose financial activities, outside the remit of the submitted work (A.W.B.: research grants; M.R.W.: research grants, lecturing, textbook royalties); no other relationships or activities that could appear to have influenced the submitted work. Funding Information: Funding: This study was supported by the NIHR Biomedical Research Center at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol ( BRC-1215-20011 ). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in considering the study design or in the collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2022",

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language = "English",

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Donovan, RL, Johnson, H, Fernando, S, Foxall-Smith, M, Whitehouse, MR, Blom, AW & Kunutsor, SK 2022, 'The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: a systematic review and meta-analysis of longitudinal observational studies', Journal of Arthroplasty, vol. 37, no. 5, pp. 993-1001.e8. https://doi.org/10.1016/j.arth.2022.01.017

The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: a systematic review and meta-analysis of longitudinal observational studies. / Donovan, Richard L; Johnson, Harvey; Fernando, Sherwin et al.
In: Journal of Arthroplasty, Vol. 37, No. 5, 17.01.2022, p. 993-1001.e8.

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

TY - JOUR

T1 - The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements

T2 - a systematic review and meta-analysis of longitudinal observational studies

AU - Donovan, Richard L

AU - Johnson, Harvey

AU - Fernando, Sherwin

AU - Foxall-Smith, Michael

AU - Whitehouse, Michael R

AU - Blom, Ashley W

AU - Kunutsor, Setor K

N1 - Funding Information: Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol for the submitted work. A.W.B. and M.R.W. disclose financial activities, outside the remit of the submitted work (A.W.B.: research grants; M.R.W.: research grants, lecturing, textbook royalties); no other relationships or activities that could appear to have influenced the submitted work. Funding Information: Funding: This study was supported by the NIHR Biomedical Research Center at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol ( BRC-1215-20011 ). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in considering the study design or in the collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the article for publication. Publisher Copyright: © 2022 Elsevier Inc.

PY - 2022/1/17

Y1 - 2022/1/17

N2 - BackgroundDislocation after a primary total hip replacement (pTHR) remains a common cause of treatment failure. Constrained acetabular components (CACs) and dual mobility implants (DMIs) may mitigate this in patients at high risk of dislocation or with significant intra-operative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation following implantation with CACs and DMIs in pTHR.MethodsLongitudinal studies reporting dislocation following the use of CACs or DMIs in pTHR were sought from MEDLINE and EMBASE to September 2020. Secondary outcomes included revision surgery for dislocation and all causes.Results46 studies (three CAC; 43 DMI) comprising 582 CACs and 18,748 DMIs were included. The pooled incidence of dislocation was 1.08% (95% CI:0.00,3.72) (range 0.27-2.60%) over a weighted mean follow-up of 4.1 years for CACs, compared with 0.25% (95% CI:0.08,0.46) (range 0.00-4.72%) over 6.2 years for DMIs. For DMIs, there was a temporal decline in dislocations from the 1980s onwards, and dislocation rates remained low (<1%) until 15 years post-operatively. There were insufficient data for similar analysis of CACs. All studies were at high risk of bias. The incidence of revision for dislocation after CACs was 0.3% versus 0.1% for DMIs, and the incidence of revision for all causes after CACs was 4.8% versus 2.7% for DMIs.ConclusionDMIs demonstrated a lower incidence of dislocation compared to CACs; however, there was a relative absence of CACs used in the context of pTHR in the literature. Temporal trends in dislocation have improved over time for DMIs.

AB - BackgroundDislocation after a primary total hip replacement (pTHR) remains a common cause of treatment failure. Constrained acetabular components (CACs) and dual mobility implants (DMIs) may mitigate this in patients at high risk of dislocation or with significant intra-operative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation following implantation with CACs and DMIs in pTHR.MethodsLongitudinal studies reporting dislocation following the use of CACs or DMIs in pTHR were sought from MEDLINE and EMBASE to September 2020. Secondary outcomes included revision surgery for dislocation and all causes.Results46 studies (three CAC; 43 DMI) comprising 582 CACs and 18,748 DMIs were included. The pooled incidence of dislocation was 1.08% (95% CI:0.00,3.72) (range 0.27-2.60%) over a weighted mean follow-up of 4.1 years for CACs, compared with 0.25% (95% CI:0.08,0.46) (range 0.00-4.72%) over 6.2 years for DMIs. For DMIs, there was a temporal decline in dislocations from the 1980s onwards, and dislocation rates remained low (<1%) until 15 years post-operatively. There were insufficient data for similar analysis of CACs. All studies were at high risk of bias. The incidence of revision for dislocation after CACs was 0.3% versus 0.1% for DMIs, and the incidence of revision for all causes after CACs was 4.8% versus 2.7% for DMIs.ConclusionDMIs demonstrated a lower incidence of dislocation compared to CACs; however, there was a relative absence of CACs used in the context of pTHR in the literature. Temporal trends in dislocation have improved over time for DMIs.

KW - arthroplasty

KW - replacement

KW - hip

KW - hip dislocation

KW - contrained acetabular componant

KW - dual mobility implant

KW - systematic review

KW - meta-analysis

U2 - 10.1016/j.arth.2022.01.017

DO - 10.1016/j.arth.2022.01.017

M3 - Review article (Academic Journal)

C2 - 35051608

SN - 0883-5403

VL - 37

SP - 993-1001.e8

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

IS - 5

ER -

Donovan RL, Johnson H, Fernando S, Foxall-Smith M, Whitehouse MR, Blom AW et al. The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: a systematic review and meta-analysis of longitudinal observational studies. Journal of Arthroplasty. 2022 Jan 17;37(5):993-1001.e8. Epub 2022 Jan 17. doi: 10.1016/j.arth.2022.01.017