Revision Arthroplasty| Volume 36, ISSUE 11, P3716-3721, November 2021

No Difference in Dislocation Rates Comparing Large Diameter Jumbo Femoral Heads and Dual-Mobility Bearings in Revision Total Hip Arthroplasty

  • Kevin A. Sonn
    Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN

    IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
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  • Evan R. Deckard
    Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
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  • R. Michael Meneghini
    Address correspondence to: R. Michael Meneghini, MD, Indiana University Health Hip and Knee Center, Professor of Clinical Orthopaedic Surgery, Indiana University School of Medicine, 13100 East 136th Street, Suite 2000, Fishers, IN 46037.
    Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN

    IU Health Hip & Knee Center, IU Health Saxony Hospital, Fishers, IN
    Search for articles by this author



      Dual-mobility (DM) bearings reduce instability in revision total hip arthroplasty (THA); however, DM bearings are costly and reports of corrosion have recently emerged. Furthermore, no study has compared DM to standard bearings with large diameter femoral heads ≥40-mm. This study’s purpose was to compare postoperative dislocation rates of standard and DM bearings with large femoral heads after revision THA.


      A retrospective review of 301 consecutive revision THAs was performed. The mean follow-up was 37.1 months. To isolate the effect of the double articulation, standard and DM bearings with femoral heads ≥40-mm were compared. Outcomes were postoperative dislocation and reoperation within 90 days.


      The cohort consisted of 182 standard bearings and 75 DM bearings. There were no differences in revision indication comparing standard and DM bearings (P = .258). Overall dislocation rate was 8.6% (22 of 257). The dislocation rate was 5.7% for standard bearings with ≥40-mm femoral heads compared with 6.9% in DM bearings with ≥40-mm femoral heads (P = 1.000). In multivariate analysis, lower body mass index (odds ratio 1.72), female sex (odds ratio 2.01), and decreased outer femoral head diameter–to–cup component size ratio (odds ratio 1.64) were predictors of postoperative dislocation regardless of bearing type.


      This study showed no difference in dislocation rates between standard and DM bearings when comparing similar femoral head diameters of ≥40-mm used in revision THAs. Considering the cost and potential deleterious issues associated with additional interfaces, DM bearings should be used judiciously considering similar results may be achieved with single-articulation bearings using large femoral heads.

      Level of Evidence

      Level III.


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        • Chang R.W.
        • Pellisier J.M.
        • Hazen G.B.
        A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip.
        JAMA. 1996; 275: 858-865
        • Lavernia C.J.
        • Iacobelli D.A.
        • Brooks L.
        • Villa J.M.
        The cost-utility of total hip arthroplasty: earlier intervention, improved economics.
        J Arthroplasty. 2015; 30: 945-949
        • Learmonth I.D.
        • Young C.
        • Rorabeck C.
        The operation of the century: total hip replacement.
        Lancet. 2007; 370: 1508-1519
        • Malkani A.L.
        • Garber A.T.
        • Ong K.L.
        • Dimar J.R.
        • Baykal D.
        • Glassman S.D.
        • et al.
        Total hip arthroplasty in patients with previous lumbar fusion surgery: are there more dislocations and revisions?.
        J Arthroplasty. 2018; 33: 1189-1193
        • Carter A.H.
        • Sheehan E.C.
        • Mortazavi S.M.J.
        • Purtill J.J.
        • Sharkey P.F.
        • Parvizi J.
        Revision for recurrent instability: what are the predictors of failure?.
        J Arthroplasty. 2011; 26: 46-52
        • Mahoney C.R.
        • Heitenberger S.
        • Sanchez P.
        • Schaefer S.H.
        • Sculco T.P.
        • Westrich G.H.
        Ultimate outcome in immediate postoperative total hip arthroplasty instability.
        J Arthroplasty. 2007; 22: 79-82
        • Patel P.D.
        • Potts A.
        • Froimson M.I.
        The dislocating hip arthroplasty: Prevention and treatment.
        J Arthroplasty. 2007; 22: 86-90
        • Sikes C.V.
        • Lai L.P.
        • Schreiber M.
        • Mont M.A.
        • Jinnah R.H.
        • Seyler T.M.
        Instability after total hip arthroplasty: treatment with large femoral heads vs constrained liners.
        J Arthroplasty. 2008; 23: 59-63
        • Abdel M.P.
        • von Roth P.
        • Jennings M.T.
        • Hanssen A.D.
        • Pagnano M.W.
        What safe zone? The vast majority of dislocated thas are within the lewinnek safe zone for acetabular component position.
        Clin Orthop Relat Res. 2016; 474: 386-391
        • AAOS
        American joint replacement registry (ajrr): 2019 annual report. Rosemont, IL.
        American Academy of Orthopaedic Surgeons (AAOS), 2019: 37-40 ([accessed 05.10.20])
        • Hartzler M.A.
        • Abdel M.P.
        • Sculco P.K.
        • Taunton M.J.
        • Pagnano M.W.
        • Hanssen A.D.
        Otto aufranc award: dual-mobility constructs in revision tha reduced dislocation, rerevision, and reoperation compared with large femoral heads.
        Clin Orthop Relat Res. 2018; 476: 293-301
        • Romagnoli M.
        • Grassi A.
        • Costa G.G.
        • Lazaro L.E.
        • Lo Presti M.
        • Zaffagnini S.
        The efficacy of dual-mobility cup in preventing dislocation after total hip arthroplasty: a systematic review and meta-analysis of comparative studies.
        Int Orthop. 2019; 43: 1071-1082
        • Harwin S.F.
        • Sultan A.A.
        • Khlopas A.
        • Chughtai M.
        • Sodhi N.
        • Piuzzi N.S.
        • et al.
        Mid-term outcomes of dual mobility acetabular cups for revision total hip arthroplasty.
        J Arthroplasty. 2018; 33: 1494-1500
        • Schmidt A.
        • Batailler C.
        • Fary C.
        • Servien E.
        • Lustig S.
        Dual mobility cups in revision total hip arthroplasty: efficient strategy to decrease dislocation risk.
        J Arthroplasty. 2019;
        • Addona J.L.
        • Gu A.
        • De Martino I.
        • Malahias M.-A.
        • Sculco T.P.
        • Sculco P.K.
        High rate of early intraprosthetic dislocations of dual mobility implants: a single surgeon series of primary and revision total hip replacements.
        J Arthroplasty. 2019; 34: 2793-2798
        • De Martino I.
        • D'Apolito R.
        • Waddell B.S.
        • McLawhorn A.S.
        • Sculco P.K.
        • Sculco T.P.
        Early intraprosthetic dislocation in dual-mobility implants: a systematic review.
        Arthroplast Today. 2017; 3: 197-202
        • Deckard E.R.
        • Azzam K.A.
        • Meneghini R.M.
        Contemporary dual mobility head penetration at five years: concern for the additional convex bearing surface?.
        J Arthroplasty. 2018; 33: S280-S284
        • Matsen Ko L.J.
        • Pollag K.E.
        • Yoo J.Y.
        • Sharkey P.F.
        Serum metal ion levels following total hip arthroplasty with modular dual mobility components.
        J Arthroplasty. 2016; 31: 186-189
        • Nam D.
        • Salih R.
        • Brown K.M.
        • Nunley R.M.
        • Barrack R.L.
        Metal ion levels in young, active patients receiving a modular, dual mobility total hip arthroplasty.
        J Arthroplasty. 2017; 32: 1581-1585
        • Romero J.
        • Wach A.
        • Silberberg S.
        • Chiu Y.-F.
        • Westrich G.
        • Wright T.M.
        • et al.
        2020 Otto aufranc award: malseating of modular dual mobility liners.
        Bone Joint J. 2020; 102-B: 20-26
        • Babovic N.
        • Trousdale R.T.
        Total hip arthroplasty using highly cross-linked polyethylene in patients younger than 50 years with minimum 10-year follow-up.
        J Arthroplasty. 2013; 28: 815-817
        • Glyn-Jones S.
        • Thomas G.E.
        • Garfjeld-Roberts P.
        • Gundle R.
        • Taylor A.
        • McLardy-Smith P.
        • et al.
        The john charnley award: highly crosslinked polyethylene in total hip arthroplasty decreases long-term wear: a double-blind randomized trial.
        Clin Orthop Relat Res. 2015; 473: 432-438
        • Jameson S.S.
        • Lees D.
        • James P.
        • Serrano-Pedraza I.
        • Partington P.F.
        • Muller S.D.
        • et al.
        Lower rates of dislocation with increased femoral head size after primary total hip replacement: a five-year analysis of nhs patients in england.
        J Bone Joint Surg Br. 2011; 93: 876-880
        • Howie D.W.
        • Holubowycz O.T.
        • Middleton R.
        • Group L.A.S.
        Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial.
        J Bone Joint Surg Am. 2012; 94: 1095-1102
        • Zijlstra W.P.
        • De Hartog B.
        • Van Steenbergen L.N.
        • Scheurs B.W.
        • Nelissen R.G.H.H.
        Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty.
        Acta Orthop. 2017; 88: 395-401
        • Garbuz D.S.
        • Masri B.A.
        • Duncan C.P.
        • Greidanus N.V.
        • Bohm E.R.
        • Petrak M.J.
        • et al.
        The frank stinchfield award: dislocation in revision tha: do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial?.
        Clin Orthop Relat Res. 2012; 470: 351-356
        • Levin J.M.
        • Sultan A.A.
        • O'Donnell J.A.
        • Sodhi N.
        • Khlopas A.
        • Piuzzi N.S.
        • et al.
        Modern dual-mobility cups in revision total hip arthroplasty: a systematic review and meta-analysis.
        J Arthroplasty. 2018; 33: 3793-3798
        • Parvizi J.
        New definition for periprosthetic joint infection.
        Am J Orthop (Belle Mead NJ). 2011; 40: 614-615
        • Mulcahy H.
        • Chew F.S.
        Current concepts of hip arthroplasty for radiologists: Part 1, features and radiographic assessment.
        AJR Am J Roentgenol. 2012; 199: 559-569
        • Restrepo C.
        • Parvizi J.
        • Kurtz S.M.
        • Sharkey P.F.
        • Hozack W.J.
        • Rothman R.H.
        The noisy ceramic hip: is component malpositioning the cause?.
        J Arthroplasty. 2008; 23: 643-649
        • Firth D.
        Bias reduction of maximum likelihood estimates.
        Biometrika. 1993; 80: 27-38
        • Heinze G.
        • Schemper M.
        A solution to the problem of separation in logistic regression.
        Stat Med. 2002; 21: 2409-2419
        • Sonn K.A.
        • Meneghini R.M.
        Adverse local tissue reaction due to acetabular corrosion in modular dual-mobility constructs.
        Arthroplast Today. 2020; 6: 976-980