Dual Mobility vs. Large Femoral Head (≥36 mm) in Primary and Revision Total Hip Arthroplasty: A Meta-Analysis of
Abdelrahman Ibrahim1, Amr Selim2,3, Christina Dwebeng1
1University Hospital of North Midlands, Stoke-on-Trent, United Kingdom.
Background:
Instability is a frequent complication after total hip arthroplasty (THA) and remains a leading cause of revision surgery. Dual mobility (DM) and large femoral heads (LFHs) have been used to mitigate this risk, particularly in high-risk patients. This study aimed to compare the postoperative outcomes of DM vs. LFH in THA.
Methods:
A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. MEDLINE, Embase, CINAHL, CENTRAL, and ClinicalTrials.gov were searched for relevant studies up to May 2025. Inclusion criteria comprised studies directly comparing DM and LFH ≥36 mm in primary and revision THA.
Results:
Eighteen studies (2 randomized controlled trials and 16 nonrandomized) involving a total of 133,474 hips (13,508 DM; 119,966 LFH) were included. The analysis revealed that LFH was associated with a significantly higher risk of dislocation compared with DM in both primary THA (odds ratio [OR] = 4.81, p < 0.001) and revision THA (OR = 1.99, p < 0.001). This was further confirmed in a time-to-event analysis for dislocation (hazard ratio = 2.67, 95% confidence interval [CI] 1.54-4.63, p < 0.001). Meta-regression adjusting for acetabular cup size showed no significant moderating effect (β = 0.19, 95% CI -0.13 to 0.51; OR = 1.20, 95% CI 0.88-1.67; p = 0.12), indicating that the protective effect of DM on dislocation risk was independent of cup size. The overall pooled analysis indicated that the risks of revision for dislocation (OR = 1.38, p = 0.02) and aseptic loosening (OR = 1.77, p = 0.02) were significantly higher with LFH.
Conclusion:
Across both primary and revision THA, LFH was associated with a significantly higher risk of dislocation, consistent in time-to-event analyses and after adjustment for acetabular cup size. The pooled analysis also showed higher risks of revision for dislocation and aseptic loosening with LFH. However, longer-term implant survival requires further investigation in future studies.
Level Of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
