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Background:
Systematic Review

Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review

by
Gianluca Ciolli
1,2,
Guillaume Mesnard
1,*,
Etienne Deroche
1,
Stanislas Gunst
1,3,
Cécile Batailler
1,3,
Elvire Servien
1,4 and
Sébastien Lustig
1,3
1
Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
2
Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Sacred Heart Catholic University, 00168 Rome, Italy
3
Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
4
LIBM—EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69622 Lyon, France
*
Author to whom correspondence should be addressed.
J. Pers. Med. 2023, 13(1), 81; https://doi.org/10.3390/jpm13010081
Submission received: 15 November 2022 / Revised: 22 December 2022 / Accepted: 25 December 2022 / Published: 29 December 2022
(This article belongs to the Special Issue Innovations in Knee and Hip Arthroplasty)
Browse Figure
Review Reports Versions Notes

Abstract

:
Background: Instability is a common complication following total hip arthroplasty (THA). The dual mobility cup (DMC) allows a reduction in the dislocation rate. The goal of this systematic review was to clarify the different uses and outcomes according to the indications of the cemented DMC (C-DMC). Methods: A systematic review was performed using the keywords “Cemented Dual Mobility Cup” or “Cemented Tripolar Cup” without a publication year limit. Of the 465 studies identified, only 56 were eligible for the study. Results: The overall number of C-DMC was 3452 in 3426 patients. The mean follow-up was 45.9 months (range 12–98.4). In most of the cases (74.5%) C-DMC was used in a revision setting. In 57.5% DMC was cemented directly into the bone, in 39.6% into an acetabular reinforcement and in 3.2% into a pre-existing cup. The overall dislocation rate was 2.9%. The most frequent postoperative complications were periprosthetic infections (2%); aseptic loosening (1.1%) and mechanical failure (0.5%). The overall revision rate was 4.4%. The average survival rate of C-DMC at the last follow-up was 93.5%. Conclusions: C-DMC represents an effective treatment option to limit the risk of dislocations and complications for both primary and revision surgery. C-DMC has good clinical outcomes and a low complication rate.

1. Introduction

The use of the dual mobility cup (DMC) is an established practice in hip replacement surgery, which could ensure higher implant stability, physiological mobility of the hip joint and reduce wear. DMC is considered one of the major current strategies to prevent and treat hip instability, which is the first reason for total hip arthroplasty (THA) revision. The excellent long-term results of DMC justify their steady increase in recent years, both in primary complex cases and in recurrent hip instability after THA [1,2,3,4,5].
DMC can be used as the first implant surgery in complex cases of osteoarthritis (OA), including obese patients or those with neuromuscular or neurological diseases; and in fractures, such as acetabular fractures, femoral neck fractures (FNF), or pathological fractures [6,7,8,9]. Another common use of DMC is in revision surgery of total or partial hip arthroplasties or following the failure of a previous osteosynthesis [10,11].
In complex cases, including bone defects, DMC can be cemented directly into the bone or acetabular brace, such as primary or revision surgery [12,13]. While many reviews in the literature investigate and describe DMC [14,15], there is no specific analysis of cemented DMC (C-DMC).
The study aims to provide a systematic review concerning the C-DMC and a specific analysis of its application, in terms of complications, clinical results, survivorship rate, and radiographic findings. Secondary objectives are to describe the outcomes of primary and revision surgery and with or without acetabular reinforcement.

2. Materials and Methods

2.1. Search Strategy and Design

A systematic literature review was performed following the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The following online electronic databases were used: Cochrane Database of Systematic Reviews, PubMed, EMBASE and Google Scholar. The search strategy had no data limit and was conducted until 31 December 2021. The following keywords, and their MeSH terms in any possible combination, were used: “Cemented Dual Mobility Cup” OR “Cemented Tripolar Cup”. A minimum mean follow-up of 1 year was considered to allow the evaluation of all early complications and outcomes.

2.2. Eligibility Criteria

Inclusion criteria were (1) patients undergoing C-DMC for any reason; (2) all levels of evidence; (3) full-text articles in indexed journals; (4) studies in English; (4) human studies; (5) mean follow-up of at least 12 months. Exclusion criteria were (1) nonoperative studies; (2) studies using different types of cups; (3) studies in which C-DMC was been used in less than 10% of cases; (4) studies in which DMC data were not specifically described; (5) reviews; (6) surveys or case reports; (7) book chapters; (8) congress abstract; (9) surgical technical reports; (10) expert opinions or letters to the editor; (11) cadaveric or animal studies.

2.3. Study Selection

The study selection was conducted by two independent reviewers (C.G. and M.G.). Articles were identified based on the title and abstract. If necessary, full-text articles were obtained to screen. After excluding the unacceptable studies, the full texts of the remaining studies were assessed. Any disagreements between reviewers were resolved through discussion with a third author (D.E.). Finally, the included articles’ references have been evaluated to highlight further relevant items useful for the search. In the case of multiple studies involving the same case series with different follow-ups, only the manuscript with the longest follow-up was selected.

2.4. Data Extraction and Analysis

A standard data extraction form was used which included the following: (1) study details: author, year, country, study design, level of evidence; (2) study population: cohort, population size, gender, age at the time of surgery, body mass index (BMI); (3) follow-up information: patients at follow-up, mean follow-up, patients lost to follow-up; (4) surgical approach to the hip; (5) C-DMC information: number, implant, cement, graft, primary or revision procedure, “cup-in-cup” technique, acetabular reinforcement; (6) outcomes: preoperative and postoperative Harris Hip Score (HSS), postoperative Postel Merle d’Aubigné (PMA); (7) postoperative complications: mechanical failures, aseptic loosening, infections, dislocations, intra-prosthetic dislocations (IPD); (8) radiographic complications: peri-acetabular radiolucent lines (RLLs), Brooker heterotopic ossification (HO); (9) survivorship rate. In the presence of comparative studies, in which the C-DMC are compared with different treatment techniques, only the C-DMC data were obtained for the study; while in the presence of overall values with the other different cups, these values were not taken into consideration for the statistics.

2.5. Methodological Quality Assessment

The study quality of all included studies was evaluated using the MINORS (Methodological Index for Non-Randomized Studies) criteria. Each item was scored from 0 to 2, with maximum scores of 16 for non-comparative studies and 24 for comparative studies. Each study included was scored by 2 authors (C.G. and M.G.).

2.6. Statistical Analysis

The kappa (k) value was used to evaluate consensus among reviewers in item selection. The agreement was classified as poor when k < 0.30, partial 0.30 < k < 0.60 and total with k > 0.60. Given the high heterogeneity among the studies, a meta-analysis was not performed; however, indirect comparisons were made.

3. Results

3.1. Literature Search and Study Characteristics

The initial search found 465 studies. After removing the duplicates, the remaining items were screened based on the title and abstract. The full texts of the remaining 86 articles were examined. Finally, according to the eligibility criteria, 56 articles were included in the systematic review [12,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68] (Figure 1).
Among the reviewers, there was excellent agreement involving the title (k = 0.90; 95% CI, 0.88 to 0.92), the abstract (k = 0.91; 95% CI, 0.89 to 0.93), and the full text (k = 0.93; 95% CI, 0.92 to 0.94). Of the selected articles published between 2008 and 2021, ten reports are comparative studies (17.9%).
Most of the studies were retrospective (n = 44, 78.6%), while the remaining were prospective (n = 12, 21.4%). Forty-two (75%) studies were level IV evidence, 12 (21.4%) studies were level III, and two (3.6%) studies were level I.
The mean MINORS score was 11 (range 10–14) and 20 (range 17–24), for the non-comparative and comparative studies, respectively.
Most of the studies were conducted in France (28.1%), Egypt and the United States (both 10.7%) (Table 1).

3.2. Overall Demographic Data

The overall number of patients was 4675 (4701 hips). Finally, 3452 C-DMC in 3426 patients were found. The patients who reached the last follow-up and who were evaluated for clinical and radiographic outcomes are 3162 (92.3%).
Females are more represented (62.9%) than males (37.1%). The mean age at the time of surgery was of 71.5 years (mean range 67–82), only one study doesn’t have the mean age value. The mean follow-up was 45.9 months (range 12–98.4). The mean BMI was 26.8 kg/m2 (range 24–29.7) (Table 1, Table 2 and Table 3).

3.3. Operative Technique and Implants

Overall, 3452 C-DMCs are included. The posterolateral approach was the most used surgical approach (75.3%). The anterior approach was used in 14% of cases, the lateral approach in 5.3% of cases, and an extensive approach was used in 5.4% of cases. The most used implant was the Avantage dual mobility cup (Zimmer Biomet©, Warsaw, IN, USA), used in 17 studies and 54.2% of all cases, followed by the DM Novae cemented cup (Serf©, Décines-Charpieux, France) (7 studies, 14.2%) (Table 2 and Table 3).

3.4. Complications and Cup Survival Rate

The overall dislocation rate from 51 studies was 3.1%. The systematic review reported 7 cases of IPD, in four different studies. The overall IPD rate is 0.2%. The most frequent postoperative complications were periprosthetic infections (3%); aseptic loosening (1.3%) and mechanical failure (0.5%). A total of 138 revisions are reported (revision rate of 4%), in 48 studies reporting data eligible for the study. The average survival rate of the DMC at the last follow-up was evaluated in 43 studies (76.8%). At 45.9 months follow-up, the overall survival rate was 93.5% (range 83.1–100) (Table 4).

3.5. Radiographic Outcomes

Among the systematic review, 36 studies (64.3%) showed radiological information about peri-acetabular radiolucent lines (RLLs), and only 26 studies (46.4%) investigated Brooker HO. The rate of periacetabular RLLs was 3.2%, while the HO rate was 6.7% (Table 5).

3.6. Functional Outcomes

The preoperative level of function was assessed with the HHS in 22 studies (59.3%). The mean preoperative HHS value was on average 43. The mean postoperative HHS value, evaluated in 34 studies (60.7%), was 76.7 (Table 5). The mean pre-operative PMA was 10.4 in 10 studies (17.9%). Instead, the post-operative PMA was 14.7, in 14 studies (25%) (Table 5).

3.7. Cemented Dual Mobility Cups in the Primary Setting

C-DMCs were used in 25.5% of cases as the primary setting, in 19 different studies (33.9%). In 40.5% of those cases, C-DMCs were used for the treatment of FNF, in 27.9% of cases as a treatment of OA complex cases, in 25.2% of cases as a treatment of pathological lesions (all cases of peri-acetabular metastasis cases except one case of pathological femur fracture) [59].
Finally, in 6.4% of the cases, a C-DMC was used in the treatment of acetabular fractures (Table 6).

3.8. Cemented Dual Mobility Cups in the Revision Setting

In 74.5% of cases, a C-DMC was used in the revision setting, such as the revision of previous THA or fixation failures. The use of C-DMC in revision cases was described in 42 studies (75%) (Table 7).

3.9. Acetabular Reinforcement

In most cases (57.5%), the C-DMCs were used without acetabular reinforcement, cementing the acetabular component directly on the bone resulting in a low loosening rate and good cup survivorship, between 93 and 100% at the last followup (Table 8).
In 39.6% of the total cases, in 30 studies, a DMC was cemented into an acetabular reinforcement.
The most common AR used were the Kerboull cross-plates and Burch–Schneider Cage (Table 9).

3.10. Cup-in-Cup Technique

DMC was cemented into a pre-existing cup following the “cup-in-cup” technique, in 106 cases (3.1%) (Table 3). In all cases, this procedure was used as a revision setting after the failure of a previous THA (Table 10).

3.11. Acetabular Bone Grafting

In the current study, the use of bone grafting was observed in 22 (39.3%) manuscripts. Overall, acetabular bone grafting has been used in 16.3% of C-DMC. In most cases, it was an allograft (93.2%), while in a minor part it was a synthetic graft (4.9%) or autograft (1.9%).
Acetabular bone grafting was used in 3% of the primary C-DMC setting and in 19% of the revision C-DMC setting. In cases where an acetabular reinforcement was utilized, acetabular bone grafting was used in 24.2% of cases, while only in 9.8% of cases in the absence of acetabular reinforcement (Table 2).

4. Discussion

This review allowed us to appreciate the satisfactory results of C-DMC. Dislocation rates found are low and the survivorship of the implants in both primary and revision surgery is satisfactory. Clinically, the improvement of the functional outcomes is significant, and radiologically, RLLs are rare.
The clinical and radiographic outcomes of cementless DMCs are excellent at medium and long follow-ups with an overall survivorship of 95% at 10-year follow-ups and demonstrated low revision and dislocation rates, without major polyethylene wear concerns [16,68,69,70,71,72,73,74,75,76,77,78,79,80].

4.1. Cemented Dual Mobility Cup in the Setting of Primary Surgery

In the present study, was observed the use of C-DMC in a primary setting in about a quarter of the surgeries (25.5%). C-DMC is an established treatment of hip OA, especially in association with other comorbidities that could increase the risk of dislocation and loosening, such as acetabular deficiency, abductor deficiency, prior acetabular fracture fixation or high-demanding physical activity patients [32].
Tabori-Jensen et al. [61] in a randomized controlled study in elderly osteoarthrosis patients with 2 years’ follow-up comparing cementless DMC with C-DMC have demonstrated that cemented fixation of the Avantage DMC seems safer in elderly patients, with less implant migration.
Moreover, C-DMC represents an option in the management of FNF. In those cases, Tarasevicius et al. [15] reported a 100% survival rate one year after treatment of 42 patients with C-DMC. Lamo-Espinosa et al. [67], in a series of 69 elderly (>75 years) and frail patients with a high risk of instability with a median follow-up time of 49.04 months, reported only one case of revision due to aseptic loosening.
Another well-recognized use of C-DMC is in cases of pathological fractures. Lavignac et al. [58] used DMC in the treatment of peri-acetabular metastasis, but although the rate of complications and revisions is low, the mean patient survivorship was 19.5 months due to the progression of the primary disease. Similarly, Wegrzyn et al. [46], in a continuous series of 131 cases of periacetabular metastatic disease treated using a DMC cemented into an acetabular reinforcement device, observed an improvement in the postoperative functional outcome and pain relief, no mechanical failure or aseptic loosening of the acetabular reconstruction and a dislocation rate of 2%.
Finally, in some cases of acetabular fractures, C-DMC could be used. In those cases, it is associated with the combined treatment of fracture reduction and fixation. As reported by Giunta et al. [38], primary C-DMC for acetabular fracture in the elderly population might be a good therapeutic option that allows a return to previous daily life activity. Lannes et al. [57] found that DMC combined with internal fixation, also known as the combined hip procedure (CHP), could be an efficient procedure in selected elderly patients, with a lower level of revision rate compared to the ORIF group alone. In the CHP group, internal fixation was performed before the hip replacement. When the anterior column was involved, a suprapectineal quadrilateral buttress plate was used through a modified Stoppa approach; otherwise, a Kocher-Langenbeck approach was performed with a posterior column or wall osteosynthesis [81,82].
These findings are important and demonstrate that primary surgery with C-DMC is an excellent treatment in complex cases of OA, FNF, acetabular fractures or periacetabular metastases in terms of survival and reduced number of complications.

4.2. Cemented Dual Mobility Cup in the Setting of Revision Surgery

As demonstrated by the results of the study, the most frequent use of C-DMC is in revision settings (74.5%).
In cases of failure of a previous THA, C-DMC has shown an excellent role in avoiding further failures and reducing the number of complications. In fact, from the Swedish Hip Arthroplasty Register, Hailer, et al. [18] revealed in a series of 228 patients that DMCs for revision due to instability are associated with a low rate (8%) of re-revisions due to dislocation.
In patients with first-time revision hip arthroplasty due to dislocation, Mohaddes et al. [31] found better short to mid-term implant survival for C-DMC compared with cemented polyethylene cups at four years of follow-up. Stucinskas et al. [44], from the Lithuanian arthroplasty register, observed a significantly lower short-term re-revision rate for dislocations at five-year follow-up, in patients treated with C-DMC (2%) compared to different surgical concepts (9%) when used for first-time hip revisions due to recurrent dislocations.
As emerges from the results of the current review, C-DMC is a valid option in a revision setting with a dislocation rate of 3% and a survival rate of approximately 95% (with a mean follow-up of 49.6 months).

4.3. Cemented Dual Mobility Cup into an Acetabular Reinforcement

In the present study, DMC was cemented in an acetabular reinforcement in the revision setting in 83.6%, while in the primary setting only in 16.4% of the cases.
Neri et al. [74] suggested the use of DMC cemented into a reinforcement cage (Kerboull cross-plate or custom reinforcement cage) in cases of acetabular defects 2C or more according to Paprosky’s classification. In a single-center continuous series of 62 patients, Lebeau et al. [30] evidenced that DMC cemented into an acetabular reinforcement at a minimum FU of five years presented good outcomes (PMA 14, HHS score 73) and only 2 cases of dislocation, while Brüggemann et al. [35], in a case series of 69 patients, demonstrated a 4-year survival of 96% and only one case of dislocation.

4.4. Cemented Dual Mobility Cup into a Pre-Existing Cup

Among the studies, a minor part (3.2%) of the DMCs was cemented into a pre-existing cup following the surgical technique described by Blumenfeld [83], known as the “Cup-in-cup” technique. This technique, developed for the treatment of acetabular defects, in the current study showed good results in terms of fewer complications and guaranteed a survival rate of 93.6% at a mean follow-up of 35.7 months (Table 10).

4.5. Bone Grafting

In the current study, the use of bone grafting was observed in 16.3% of C-DMC. In most cases, bone grafting was used in a revision setting, in combination with acetabular reinforcement, using an allograft. Bone grafting could help the surgeon in cases of loss of acetabular bone stock and unstable components fixation and can be easily combined with cemented fixation of the DMC [84].

4.6. C-DMC Complications and Outcomes

In the current review, the overall dislocation rate was 2.9%, and at 45.9 months follow-up, the overall survival rate was 93.5%. These data are similar to the mean rates of dislocation and medium-term survival of single-mobility THA or cementless DMC [25,85,86]. These results must be considered even more due to the use of the C-DMC especially in complex cases or in revision settings.
The overall IPD rate was 0.2%. First described in 2004 by Lecuire [87], intra-prosthetic dislocation (IPD) is a specific complication of DMC. IPD is defined as excessive “wear” of the head-liner interface which induces the separation of the head from the polyethylene, but the present systematic review reported only 7 cases of IPD, showing that this complication is now extremely rare.
Overall, C-DMC demonstrates to be a valid treatment in primary complex cases, such as in revision settings, in terms of survival and reduced number of complications.
The greatest strength of the article is to represent the only systematic review specifically focused on the C-DMC present in the literature. Moreover, over three thousand C-DMCs are considered in the systematic review. Limitations of the study are represented by the low average level of evidence, most of the studies have a level IV of evidence. Furthermore, the nature of the inclusion criteria may have minimally altered the results, due to the wide heterogeneity of the patients included. However, it is assumed that in such a large case series, this possible bias could be minimized.

5. Conclusions

The use of C-DMCs is an option used mainly in THA revision surgery, although it also exists in a primary setting. It represents an effective treatment option with good clinical outcomes. The complication rate remains moderate, with a low rate of dislocation in both primary and revision surgery. The loosening and revision rates are also low. These results can be observed whether the implant is cemented directly into the bone or cemented in acetabular reinforcement or a previous well-fixed cup. An acetabular reinforcement was used in almost 40% of cases.”

Author Contributions

G.C. and G.M. wrote the manuscript. G.C., G.M., E.D. and S.G. collected the data. C.B. provided data analysis. E.S. and S.L. are the senior authors who designed the study and reviewed the manuscript. The authors approved the submitted version. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The authors confirm that the data supporting the findings of this study are available within the article.

Conflicts of Interest

G.C., G.M., E.D., S.G. and C.B.: No conflict of interest. E.S.: institutional research support from Corin. S.L.: Consultant for Stryker, Smith and Nephew, Heraeus, Depuy Synthes. Institutional research support to Lepine and Amplitude. Editorial Board for Journal of Bone and Joint Surgery (Am).

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Jpm 13 00081 g001 550
Figure 1. Prisma Flowchart from the identification to the inclusion.
Figure 1. Prisma Flowchart from the identification to the inclusion.
Jpm 13 00081 g001
Table
Table 1. Characteristics of studies included in the review.
Table 1. Characteristics of studies included in the review.
AuthorYearNationalityTypeLevel of EvidenceNumber of PatiensMalesFemalesMean Age (SD) [Range]BMI (kg/m2) (SD) [Range]Cemented DMCPatients at
Follow-Up		Follow-up (Months) (SD) [Range]MINORS
Langlais2008franceRetrospectiveIV82//72 [65–86]/887936 [24–60]12
Philippot2009franceRetrospectiveIV51//68.7 [34–92]/515160.4 (±17.6) [24–112]12
Tarasevicius2010SwedenRetrospective comparativeIII42//75 (±10) 42421219
Schneider2011FranceRetrospectiveIV96257169.9 [34–95]/967741 (±29) [1–101]11
Civinini2012ItalyProspectiveIV24//69 [51.3–82.4]/242439.6 [24–60]14
Hailer2012SwedenRetrospectiveIV200////2002002410
Pattyn2012BelgiumRetrospectiveIV36162070.4 [46–93]/373616 [6–27]11
Mukka2013SwedenRetrospectiveIV34132175.7 [58–90]/343418 [6–36]11
Toro-Ibarguen2014SpainRetrospectiveIV14//67.8 [29–90]/141464.810
Wegrzyn2014franceProspectiveIV61293267 (±10)26 (±9)616189 (±23) [60–138]10
Haen2015FranceRetrospectiveIV64//79.8 (±11.1) [40–95]/664250.412
Simian2015FranceRetrospectiveIV47//67.9 (±9.3) [38–90]/474787.6 [60–137]11
van Heumen2015The NetherlandsRetrospectiveIV46//67 [32–90]27.2 [16.6–43.0]464629 [12–66]11
Carulli C2016ItalyRetrospectiveIV11131875.4 [71–86]/111145.6 [24–84]11
Luthra2016OmanRetrospectiveIV63353061 [23–91]/636360 [18–72]11
Plummer2016USARetrospectiveIV11//64 (42–87)28.6 [20.8–43.6]111128.8 [24–48]12
Hamadouche2017FranceRetrospectiveIV51123971.4 (±11.5) [41.1–91.8]26.4 (±6.5) [17.6–56.6]513098.4 [60–156]10
Lebeau2017FranceRetrospectiveIV62204270.5 (±11.1) [36–94]27.2 (±4.8) [19.5–43]626276.8 [60–108]10
Mohaddes2017SwedenRetrospective comparativeIII43615428275 (±9)/43643637.220
Nabil2017EgyptProspectiveIV12//56.6 [34–63]/12122420
Stambough2017USARetrospectiveIV8//60.6 [51–71]/8834.8 [24–63.6]12
Bruggemann2018SwedenRetrospective comparativeIII69343567 [35–88]/694458.8 [6–106.8]17
Chalmers2018USARetrospectiveIV1861264 [37–81]28 [19–47]181836 [24–60]12
Evangelista2018USARetrospectiveIV189962 [30–86]29 [19–37]181636 [25–56]11
Hipfl2018GermanyRetrospectiveIV15//70 [42–85]26 [17–38]151547 [25–84]11
Kavcic2018SloveniaRetrospectiveIV1744712776.8 [54–98]/17415692.4 [60–120]11
Ozden2018TurkeyProspectiveIV1431164.5 [33–89]28.8 (±5.2) [18.7–36.2]151438.1 [24–98]13
Rashed2018EgyptProspectiveIV31161566.4 (± 5.9)/32311213
Spaans2018The NetherlandsRetrospective comparativeIII96385873.1 (±8.5)26.3 (4.5)1029627.6 [3–84]19
Stucinskas2018LithuanianRetrospectiveIV2369615172 (±12)/2362362410
Tabori-Jensen2018DenmarkProspective comparativeIII56104676.5 (42–93)/56563619
Wegrzyn2018FranceProspectiveIV126487864 (±13)24 (±4)13112633 (±17)12
Assi2019LebanonRetrospective comparativeIII1631369.2 (±14.8)/161672.9 (±40.5)20
Dikmen2019TurkeyProspectiveIV3032766.1 [33–89]26.8 (±7.2) [19.7–36.2]303042.2 [24.6–75.1]12
Fathy2019EgyptProspectiveIV2012866.8 [55–80]/20202414
Gabor2019USARetrospectiveIV38182062.7 (±9.7)29.7 (±7.0)383817.910
Giunta2019FranceRetrospectiveIV2723468.5 (±8.1) [60–84]/272548 [12–84]12
Plummer2019USARetrospectiveIV19//64 [48–81]27.9 [18.5–38]19132412
Schmidt-Braekling2019GermanyRetrospectiveIV79245568.5 [41–87]26.8 [18.6–41.5]797163.6 [24–122.4]12
Wheelton2019England (UK)RetrospectiveIV54124278 [49–97]/545422.8 [6–60]11
de l’Escalopier2020FranceRetrospectiveIII76235871 [31–90]25.2 [17.2–38]766376.8 [36–144]10
Lannes2020SwitzerlandRetrospective comparativeIII26151178 (±6) [66–88]/262512 [1–96]19
Lavignac2020FranceRetrospectiveIV71276462 (±10.5) [38–88]/717128.2 (±2.9) [0.3–124.8]10
Mahmoud2020EgyptProspectiveIV2011965.85 (±5.58) [58–78]/20202414
Sayac2020FranceRetrospectiveIV74245070 (±11.3) [34–88]/7739128.4 [25.2–194.4]12
Schmidt2020FranceRetrospective comparativeIV59//69 (±13.2) [19–92]26.5 (±5.1) [17–46]595924 [12–141.6]20
Tabori-Jensen2020DenmarkProsective randomized trialI29141575 [70–82]28 [23–39]29292424
Wegrzyn2020SwitzerlandRetrospectiveIV28171182 [74–93]25 [20–39]282842 [24–60]12
Bellova2021GermanyRetrospectiveIV33//78.6 (±7.1) [63–93]/331928.5 (±17.3) [3–64]10
Bozon2021franceRetrospective comparativeIII23121167 (±10)24 (±3)2323108 (±12)18
Elkhadrawe2021EgyptProspectiveIV31161566.6 (±6.3)/32301213
Lamo Espinosa2021SpainRetrospectiveIV68155381.7 (± 6.4)/686849 (±22.6)12
Moreta2021SpainRetrospectiveIV10//79.2 [71–87]27.5 [19–34]101042 [24–72]12
Rashed2021EgyptProspectiveI31161566.38 [63.9–68.7]/31301223
Unter Ecker2021GermanyRetrospectiveIII2169612069 (±9)29 (±7)21621669 [60–110]10
Uriarte2021SpainRetrospective comparativeIV44133176.3 (±6.7)25.8 (±4.1)444449.220
Totals and proportions 34261018 (37.1%)1729 (62.9%) Mean: 26.8 kg/m234523239 (94.5%)
Table
Table 2. Cemented dual mobility cup: surgical information.
Table 2. Cemented dual mobility cup: surgical information.
AuthorYearCemented DMCPosterior ApproachLateral ApproachAnterior ApproachExtensile ApproachAvantage (Zimmer Biomet)Polarcup (Smith and Nephew)Ecofit (Implantcast)TornierADM (Stryker)MDM (Stryker)Medial Cup (Aston Medical)SaturneTM (Amplitude)Novae (SERF)Symbol Cup DM (Dedienne santé)Quattro (Lepine)Apogee (Biotechni Inc.)ADES (ZimmerBiomet)DMS (SEM)Cement Palacos R+G (Heraeus)CMW Type 3 with Gentamycin (DePuy)Antibiotic-Loaded Cement Simplex (Stryker)GraftAutoGraftAlloGraftSynthetic Graft
Langlais2008884000480000008800000000000000
Philippot200951////000000005100000///////
Tarasevicius201042420004200000000000000000000
Schneider2011969600000000000960000000091000
Civinini201224////2400000000///00100300300
Hailer2012200////20000000000000000000000
Pattyn201237370000000000000037001000000
Mukka201334340003400000000000000000000
Toro-Ibarguen201414////0140000000000000000000
Wegrzyn20146161000000000061000000100610610
Haen201566660000000000660000001003120
Simian20154747000000000000000047000230230
van Heumen201546460004600000000000000006000
Carulli C20161101100110000000000000///////
Luthra201663650006300000000000001000000
Plummer20161110001030062000000000000000
Hamadouche201751173031000000510000000010151131
Lebeau20176262000000000000062000100580580
Mohaddes20174362830140043600000000000000000000
Nabil20171201200//////////////0001010
Stambough201788000000026000000000001000
Bruggemann2018690690069000000000000010016000
Chalmers201818110700000180000000000000000
Evangelista20181800000180000000000000000000
Hipfl2018150000015000000000000100150150
Kavcic201817400174017400000000000000000000
Ozden201815150000150000000000000005000
Rashed201832320000032000000000000000000
Spaans2018102102000102000000000000000110201020
Stucinskas201823623683022700000000090000000000
Tabori-Jensen201856560000000000560000001000000
Wegrzyn201813113100000000000131000001000000
Assi20191616000//////////////00016000
Dikmen2019303000003000000000000000014000
Fathy201920020002000000000000000004000
Gabor201938271100038000000000000000180180
Giunta201927270600002700000000000006600
Plummer20191919000000001900000000000190019
Schmidt-Braekling201979////60019000000000000000000
Wheelton2019540000/////////000000000000
de l’Escalopier20207600076000000760000000010390390
Lannes202026260000000000002600000000000
Lavignac2020710000/////////000000000000
Mahmoud20202002000/////////000000000000
Sayac202077770000000000077000000000000
Schmidt202059590000000000000590000000000
Tabori-Jensen202029290002900000000000001000000
Wegrzyn202028280000000000002800001000000
Bellova202133330000294000000000001000000
Bozon20212323000000230000000000000210210
Elkhadrawe20213232000//////////////0000000
Lamo Espinosa2021680068060000000510001100000000
Moreta20211040600000000010000000000000
Rashed202131310000031000000000000000000
Unter Ecker202121621600021600000000000000000000
Uriarte20214400000000000044000000100000
Table
Table 3. Cemented dual mobility cup: surgical setting.
Table 3. Cemented dual mobility cup: surgical setting.
AuthorYearCemented DMCPrimary SettingRevision SettingNo Acetabular ReinforcementAcetabular ReinforcementCup-in-Cup
Langlais2008880887810
Philippot2009510510510
Tarasevicius2010424204200
Schneider2011960960960
Civinini2012240240240
Hailer20122000200//0
Pattyn2012370370370
Mukka2013349253400
Toro-Ibarguen2014140140140
Wegrzyn2014610610610
Haen20156632346600
Simian20154704724230
van Heumen2015460464600
Carulli C2016110111100
Luthra20166330336300
Plummer2016110110110
Hamadouche20175105129220
Lebeau2017620620620
Mohaddes2017436043643600
Nabil2017121201110
Stambough2017808008
Bruggemann2018690690690
Chalmers2018180180018
Evangelista2018180180018
Hipfl2018150150150
Kavcic2018174173117400
Ozden201815015690
Rashed2018323203200
Spaans2018102010210200
Stucinskas2018236023623600
Tabori-Jensen2018565605600
Wegrzyn2018131131001310
Assi2019160160160
Dikmen20193003011190
Fathy2019200202000
Gabor20193803827110
Giunta2019272704230
Plummer2019191900190
Schmidt-Braekling2019790790790
Wheelton2019540545400
de l’Escalopier20207607623530
Lannes2020262600260
Lavignac2020717100710
Mahmoud2020201552000
Sayac2020770770770
Schmidt2020590590590
Tabori-Jensen2020292902900
Wegrzyn2020280280028
Bellova2021330330033
Bozon2021230230230
Elkhadrawe2021323203200
Lamo Espinosa2021686806800
Moreta2021100100010
Rashed2021313103100
Unter Ecker20212160216NANANA
Uriarte2021444404400
Totals and proportions 3452879 (25.5%)2573 (74.5%)1738 (57.2%)1183 (39%)115 (3.8%)
Table
Table 4. Cemented dual mobility cup: complications.
Table 4. Cemented dual mobility cup: complications.
AuthorYearC-DMCDislocationsIntra-Prosthetic DislocationsInfectionAseptic LooseningMechanical FailureRevisionsCup-Survivorship
Langlais200888012003100%
Philippot20095160321/86.8%
Tarasevicius20104200000087%
Schneider201196110512496%
Civinini201224001001100%
Hailer20122003044210/
Pattyn20123720101297%
Mukka20133420300091.2%
Toro-Ibarguen20141410////91.2%
Wegrzyn20146100001096%
Haen201566000101100%
Simian20154710600/100%
van Heumen201546002103100%
Carulli C201611000000/
Luthra201663101001/
Plummer20161110202498%
Hamadouche20175112220793%
Lebeau20176210750875.2%
Mohaddes20174367015221089%
Nabil201712000000100%
Stambough2017820000/98.5%
Bruggemann20186910020294.6%
Chalmers20181821000292.3%
Evangelista201818000000/
Hipfl20181510200/91.9%
Kavcic201817400200098%
Ozden201815000202100%
Rashed20183200100196%
Spaans2018102301405/
Stucinskas20182365051011/
Tabori-Jensen20185610010/100%
Wegrzyn201813130400093%
Assi20191600000098.80%
Dikmen201930101203/
Fathy20192010000096.80%
Gabor20193810100193.75
Giunta201927300000/
Plummer20191900200172.1%
Schmidt-Braekling20197920540990%
Wheelton20195400100195.8%
de l’Escalopier20207623210//
Lannes20202620200285%
Lavignac202071101046/83.10%
Mahmoud202020000000100%
Sayac20207770230685%
Schmidt20205940///1395.6%
Tabori-Jensen202029000000100%
Wegrzyn202028000000/
Bellova20213320101297.3%
Bozon20212310320293%
Elkhadrawe20213200100198%
Lamo Espinosa202168000101/
Moreta20211010000192.2%
Rashed202131001000/
Unter Ecker202121624000017100%
Uriarte202144002001/
Totals and proportions3452107 (3.1%)7 (0.2%)103 (3%)45 (1.3%)18 (0.5%)138 (4%)Mean: 93.5%
Table
Table 5. Cemented dual mobility cup: radiographic and functional outcomes.
Table 5. Cemented dual mobility cup: radiographic and functional outcomes.
AuthorPatiensPatients at Follow-UpAcetabular
Components
Radiolucent Lines		Brooker Heterotopic
Ossification		Pre-Operative HHSPost-Operative HHSPre-Operative PMAPost-Operative PMA
Langlais82792/26.287.4 ± 12.1//
Philippot5151///59.4 ± 22.2 (29–91)//
Tarasevicius42423//82 ± 18 (40–100)11 ± 315.5 ± 3 (11–18)
Schneider96770//77 (25–100)//
Civinini242434////
Hailer2002000/47 (37–60)81 (62–98)//
Pattyn363615/48 (32–68)86 (66–95)//
Mukka34340///12.9 (5–18)16.3 (10–18)
Toro-Ibarguen1414//42.8 ± 6.7 (34–60)87.3 ± 5.8 (75–98)//
Wegrzyn6161//////
Haen644202/92.6 ± 11.1//
Simian4751//46 (40–79)65 (41–97)//
van Heumen46461/40 (23–44)86 (79–96)//
Carulli C11110/50 (35–78)78 (49–95)//
Luthra6363///70.4 ± 23 (24–90)/14.3 ± 4.2 (7–18)
Plummer111130///15.5 ± 1.9 (9–18)
Hamadouche513000////
Lebeau62629///13.5 ± 4.0 (8–18)16.3 ± 1.6 (13–18)
Mohaddes4364360/30 (15–51)71 (40–89)//
Nabil12120031.7 (20–81)84.5 (32–100)//
Stambough812////10.3115.61
Bruggemann69443////16.1
Chalmers181806/72.36 ± 11.65//
Evangelista1816//////
Hipfl15152/49 ± 16 (17–90)73 ± 21 (24–99)11 ± 3 (3–18)14.4 ± 3.6 (3–18)
Kavcic17415600////
Ozden1414//25.95 ± 9.91 (14–44)92.45 ± 2.74 (88–98)//
Rashed3131//////
Spaans96960049.3 (33–62)71.3 (22–91)10.112.8
Stucinskas236236///67 (±14)//
Tabori-Jensen5656/039.487.6//
Wegrzyn12625004286 (49–93)//
Assi1616//////
de l’Escalopier7663004590//
Dikmen30300034 (27–41)82 (66–95)//
Fathy202020/92.8 (88.2–97.4)//
Gabor383802/92.8 (SD 11.1)//
Giunta27250039.95 (6–84)/8.05 (3–16)/
Moreta101042939.5 ± 9.6 [37–43]71.3 ± 148.1 ± 2.5 [7–9]15.3 ± 2.2 [15–16]
Plummer1913//////
Sayac7439///73.0 (24–99)//
Schmidt5959617//9.6 ± 3.06 (2–16)15.5 ± 2.32 (7–18)
Schmidt-Braekling797130/80.4 ± 12.9 (51–98)/15.2 ± 2 (11–18)
Wheelton5454//////
Lannes2625//////
Lavignac7191//////
Mahmoud20200056 (±12)92 (8.7)//
Rashed313097/78.8 (31–100)//
Tabori-Jensen2929//////
Wegrzyn2828////5.48 (SD 2.41)10.5 (SD 3.82)
Bellova3319416/76.9 (16.8)/13.1 (3.3)
Bozon232300////
Elkhadrawe31303053 ± 1979 ± 13//
Lamo Espinosa68680037 ± 884 ± 7//
Unter Ecker2162160071 (69–74)88 (82–95)//
Uriarte4444/0////
Totals and proportions34263162 (92.3%)72 (3.2%)83 (6.7%)Mean: 43Mean: 76.7Mean: 10.4Mean: 14.7
Table
Table 6. Cemented dual mobility cup in the primary setting.
Table 6. Cemented dual mobility cup in the primary setting.
AuthorYearC-DMC Primary SettingPrimary (FNF)Primary (AO)Primary (Oncology)Primary (Acetabular Fracture)No Acetabular ReinforcementAcetabular ReinforcementDislocationsIntra-Prosthetic DislocationsRevisionsMechanical FailureAseptic LooseningInfectionPosterior ApproachLateral ApproachAnterior ApproachCup-Survivorship
Tarasevicius201042420004200000004200100%
Mukka2013909009020000390094.1%
Haen201532122000320001010320098% [94–100]
Luthra20163091803300101001300098%
Nabil201712012001110000000120100%
Kavcic2018173888500173000000200173100%
Rashed20183232000320001001320093.75%
Tabori-Jensen20185656000560/0/0105600/
Wegrzyn2018131001310013130000413100/
Giunta201927000274233000002706/
Plummer201919001900190010021900/
Lannes20202600026026202002260092.3%
Lavignac2020710071007110/6410////
Mahmoud202015104101500000000150100%
Tabori-Jensen202029029002900000002900100%
Elkhadrawe202132320003200010013200100%
Lamo Espinosa20216806800680001010006898.5%
Rashed202131310003100000013100/
Uriarte20214444000440001002///97.3% [93.5–100]
Totals and proportions879356 (40.5%)245 (27.9%)222 (25.2%)56 (6.4%)608 (69.2%)271 (30.8%)12 (1.5%)09 (1.2%)6 (0.7%)7 (0.8%)29 (8.1%)496 (64.4%)27 (3.5%)247 (32.1%)Mean: 98.5 %
Table
Table 7. Cemented dual mobility cup in the revision setting.
Table 7. Cemented dual mobility cup in the revision setting.
AuthorYearC-DMC Revision SettingNo Acetabular ReinforcementAcetabular ReinforcementCup-in-CupPosterior/Posterolateral ApproachLateral ApproachAnterior/Anterolateral ApproachExtensile ApproachGraftComplications (Dislocations)Complications (IPD)Complications (Revisions)Complications (Mechanical Failure)Complications (Aseptic Loosening)Complications (Infection)Cup-Survivorship
Langlais2008887810400048001300294.6%
Philippot2009510510/////60/12398.8%
Schneider20119609609600091110421595.6% (95% CI, 93.3–97.7%)
Civinini2012240240////3000100197% (95% CI, 82–98%)
Hailer2012200//0////0301024493% (95% CI, 90–97%)
Pattyn2012370370370000202101/
Mukka201325250025000020000394.11%
Toro-Ibarguen2014140140////010/////
Wegrzyn2014610610610006100010098%
Haen201534340034000300101098% (95% CI, 94–100%)
Simian20154724230470002310/00690% (95% CI, 84–95%)
van Heumen201546460046000600301293% (95% CI, 79–98%)
Carulli C201611110001100/000000100%
Luthra201633330033000010100198%
Plummer2016110110100010104202/
Hamadouche20175129220173/311512702275.2 ± 9.3% (95% CI, 56.9–93.5%)
Lebeau2017620620620005810805791.9%
Mohaddes201743643600285/140/07010221596%
Stambough201780088000120/00085%
Bruggemann2018690690069001610202096% (95% CI, 90–100%)
Chalmers2018180018110700212000/
Evangelista2018180018////0000000100%
Hipfl2018150150////1510/00289 (72–96)
Ozden20181569015000500202093% (95% CI, 88–98.7%)
Spaans20181021020010200010230504195.8% (3 months–7 years) (95% CI, 91.7–99.9%)
Stucinskas201823623600////0501101595.14%
Assi20191601601600016000000100%
de l’Escalopier20197623530000763923/01291.2 ± 3.8%
Dikmen20193011190300001410302191.2% (95% CI, 81.6–100%)
Fathy2019202000020004100000100%
Gabor2019382711027110018101001/
Moreta201910001040600101000/
Sayac201977077077000070603292.2%
Schmidt20195905905900004013///72.1%
Schmidt-Braekling2019790790////020904585%
Wheelton2019545400////0001001/
Mahmoud2020550005000000000100%
Wegrzyn2020280028280000000000100%
Bellova202133003333000020210186.8%
Bozon2021230230230002110202387% (95% CI, 94.7–72.3)
Unter Ecker2021216///21600002401700096%
Totals and proportions 25721129 (52.4%)912 (42.3%)115 (5.3%)1442 (77.1%)119 (6.4%)153 (8.2%)156 (8.3%)538 (21.4%)97 (3.8%)7 (0.3%)131 (5.1%)12 (0.5%)39 (1.5%)78 (3%)93.6%
Table
Table 8. Cemented DMC without acetabular reinforcement.
Table 8. Cemented DMC without acetabular reinforcement.
AuthorYearC-DMC without Acetabular ReinforcementPrimary SettingRevision SettingGraftDislocationsIPDMechanical FailureAseptic LooseningInfectionRevisionsCup-Survivorship
Tarasevicius2010424200000000100%
Mukka201334925020003394.1%
Carulli C201511011/000000100%
Haen2015663234300010198%
Simian201524024//000///
van Heumen201546046600012393%
Luthra2016633033000001198%
Hamadouche201729029///0////
Mohaddes2017436043607022151096%
Nabil2017111101000000100%
Kavcic201817417310000020100%
Ozden2018606/000/0//
Rashed201832320000001193.75%
Spaans2018102010210230041595.8%
Stucinskas201823602360500151194.9%
Tabori-Jensen201856560010010//
de l’Escalopier201923023///0////
Dikmen201911011//00////
Fathy2019200204100000100%
Gabor201927027//000///
Wheelton2019540540000011100%
Mahmoud2020201550000000100%
Rashed202031310000001096.8%
Tabori-Jensen2020292900000000100%
Elkhadrawe2021323200000011100%
Lamo Espinosa202168680000010198.5%
Uriarte202144440000002193.3%
Totals and proportions 1727604 (35%)1123 (65%)116 (7.3%)19 (1.2%)02 (0.1%)11 (0.7%)35 (2.2%)39 (2.5%)Mean: 96.9%
Table
Table 9. Cemented DMC with acetabular reinforcement.
Table 9. Cemented DMC with acetabular reinforcement.
AuthorYearC-DMC with
Acetabular Reinforcement		Acetabular
Reinforcement		Primary SettingRevision SettingGraftDislocationsIntra-Prosthetic DislocationsMechanical FailureAseptic LooseningInfectionRevisionsCup-Survivorship
Langlais200881Kerboull Cross-Plate081001002394.6%
Philippot2009517 Novae Arm cage/Kerboull cross (44)051/60123/98.80%
Schneider20119670 Kerboull cross-plate, 6 Burch-Schneider antiprotrusio cage, 20 custom-fit Novae ARM cage09691110215495.6%
Civinini201224Contour acetabular ring (Smith & Nephew, London, UK)0243000001197%
Pattyn20123735 Ganz ring (Zimmer Inc., Warsaw, IN, USA), 2 Burch Schneider ring (Zimmer Inc., Warsaw, IN, USA)0370201012/
Toro-Ibarguen20141415 Protrusio cage [DePuy Orthopaedics, Inc, Warsaw, IN], 22 Contour [Smith and Nephew Richards, Memphis, TN, USA]014010/////
Wegrzyn201461Kerboull Cross-Plate0616100100098%
Simian201523Ganz Reinforcement Ring (Zimmer, Warsaw, IN, USA)023//000///
Plummer201611/0110102024/
Hamadouche201722Kerboull acetabular reinforcement022///0////
Lebeau20176247 Müller ring, 8 Burch-Schneider ring, 4 Link reinforcement0625810057891.9%
Bruggemann201869/0691610020296%
Hipfl201815titanium acetabular cage (Zimmer Biomet)0151520002/89%
Ozden20189Contour Acetabular Reinforcement Ring (Smith & Nephew)09/000/0//
Wegrzyn2018131Kerboull cross-plate or Burch-Schneider anti-protrusio cage13100300040/
Assi201916Kerboull cross-plate01616000000100%
Dikmen201919Contour Acetabular Reconstruction Ring (Smith & Nephew)019//00////
Gabor201911/011//000///
Giunta201923Kerboull cross-plate2306300000/
Plummer201919triflange titanium acetabular cage (Restoration GAP Acetabular Cup; Stryker)19019000021/
Schmidt-Braekling201979Burch–Schneider Cage (Zimmer, Warsaw, IN, USA)079020045985%
de l’Escalopier202053Kerboull acetabular reinforcement device (KARD, Zimmer-Biomet, Warsaw, IN, USA)053///0////
Lannes202026Ganz ring (Zimmer-Biomet®, Warsaw, IN, USA)260020002292.3%
Lavignac202071Kerboull cross-plate, Muller ring, Burch-Schneider cage7100106410//
Sayac202077Kerboull cross-plate, Burch-Schneider antiprotrusio cage, custom-fit Novae ARM cage077070032692.2%
Schmidt202059Kerboull cross-plate, Burch-Schneider ring, or jumbo metal-back059040///1372.1%
Bozon202123Kerboull reinforcement device (316 L, Aston Medical, Saint-Étienne, France)0232110023287%
Totals and proportions1182 270 (22.8%)912 (77.2%)333 (33.5%)48 (4.5%)1 (0.09%)13 (1.2%)23 (2.3%)51 (5.2%)57 (6.4%)Mean: 91.7%
Table
Table 10. Cemented DMC: cup-in-cup technique.
Table 10. Cemented DMC: cup-in-cup technique.
AuthorYearCemented DMCDislocationsIPDRevisionsMechanical FailureAseptic LooseningInfectionsAcetabular Components RLLsBrooker HOPreoperative HHSPostperative HHSPreoperative PMAPostoperative PMARevisionsPosterior ApproachLateral ApproachAnterior ApproachFollow-up (Months) (SD) [Range]Cup-Survivorship
Stambough20178202001/ ////880034.8 [24–63.6]85%
Chalmers2018182120000/47 [37–60]81 [62-98]//18110736 [24–60]/
Evangelista201818000000//46 [40–79]65 [41–97]//1800036 [25–56]100%
Wegrzyn2020280000000071 [69–74]88 [82–95]//28280042 [24–60]100%
Bellova202133202101///59.4 (±22.2) [29–91]//33330028.5 (±17.3) [3–64]86.8%
Moreta2021101010000049.3 [33–62]71.3 [22–91]10.112.81040642 [24–72]/
Totals and proportions1154.7%0.9%4.7%0.9%0%0.9%0%0%Mean: 56.4Mean: 74.8Mean: 10.1Mean: 12.8100%86.6%0%13.4%Mean: 35.7Mean: 93.6%
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MDPI and ACS Style

Ciolli, G.; Mesnard, G.; Deroche, E.; Gunst, S.; Batailler, C.; Servien, E.; Lustig, S. Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J. Pers. Med. 2023, 13, 81. https://doi.org/10.3390/jpm13010081

AMA Style

Ciolli G, Mesnard G, Deroche E, Gunst S, Batailler C, Servien E, Lustig S. Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review. Journal of Personalized Medicine. 2023; 13(1):81. https://doi.org/10.3390/jpm13010081

Chicago/Turabian Style

Ciolli, Gianluca, Guillaume Mesnard, Etienne Deroche, Stanislas Gunst, Cécile Batailler, Elvire Servien, and Sébastien Lustig. 2023. "Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review" Journal of Personalized Medicine 13, no. 1: 81. https://doi.org/10.3390/jpm13010081

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