Dual-mobility cups could yield lesser infections than conventional cups: a meta-analysis of comparative studies.
INTRODUCTION
Dual-mobility cups (DMC) are gaining popularity mainly for their reduced rate of dislocation following total hip arthroplasty (THA). Currently, indication for DMC use extends beyond patients with high risk of dislocation or revision THA cases. Many authors reported DMC outcomes in primary THA for all aetiologies. However, some reports claimed that the use of DMC is accompanied with higher rates of infection compared with conventional cups (CC) in both primary and revision THA.


RESEARCH QUESTION
Does the use of DMC generate higher rates of infection when compared with conventional cups?


OBJECTIVES
The aim of this meta-analysis was to look for significant difference in the rate of post-operative infection between DMC cups and conventional cups.


METHODOLOGY
MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched since inception. Only studies with comparative design reporting the outcome infection rate were included.


RESULTS
Seventeen retrospective comparative studies were located comprising 248,541 patients: 16,020 in the DMC group and 232,521 in the CC group. The mean follow-up period was 37.5 ± 42 and 50.2 ± 48.7 months for the DMC and CC groups, respectively. The meta-analytical results indicated the following: (a) significantly lesser infections following DMC compared with CC in revision THA (odds ratio (OR) = 0.75 (95% CI = 0.653 to 0.874, P = 0.0002, I2 = 25%); (b) for primary THA and for large-sampled registries, significance was found using only the fixed-effects model estimate; and (c) no significant difference was found for the subgroup of cohort studies.


CONCLUSION
Our results clearly refute the claim that DMC would yield higher rates of infection. On the contrary, the findings demonstrated that the use of DMC reduces the risk of post-operative infection in revision THA and a similar lower infection trend for primary THA when compared with the standard cups.
['Assi|Chahine|C|', 'Mansour|Jad|J|', 'Prudhon|Jean Louis|JL|', 'Caton|Jacques|J|', 'Yammine|Kaissar|K|0000-0003-0094-9892']
D019644:Arthroplasty, Replacement, Hip D006617:Hip Dislocation D006622:Hip Prosthesis D006801:Humans D011474:Prosthesis Design D011475:Prosthesis Failure D012086:Reoperation D012189:Retrospective Studies
Dual-mobility cups Conventional cups Post-operative infection Standard cups Primary total hip arthroplasty Revision total hip arthroplasty