Text

Objectives and questions: Dual-mobility cups (DMCs) are increasingly used to prevent dislocation in revision total hip arthroplasty (THA). However, it remains unclear which risk factors influence revision and complication rates. The objective of this study was to analyze the long-term outcomes of DMCs and identify potential risk factors for revision and implant failure in revision THA

Material and mtehods: In this retrospective single-center study, all patients who received a DMC during revision THA between 2010 and 2024 at a specialized arthroplasty center were included. Demographic data and comorbidities (e.g., ASA score, nicotine abuse, BMI, osteoporosis, and other medical conditions) as well as postoperative complications were recorded. Implant survival was assessed using Kaplan–Meier analysis, and subgroup differences were evaluated with the log rank test. In a subgroup analysis, the influence of comorbidities on the risk of septic loosening and postoperative infections was investigated via logistic regression (odds ratios, OR).

Results: A total of 260 patients were included. Kaplan–Meier analysis indicated a trend toward increased revision rates in patients with renal insufficiency (p = 0.074), while patients with cardiovascular disease (p = 0.045) showed a significantly higher rate of re-revision. The most frequent causes of re-revision were aseptic loosening (3.1%), periprosthetic infection (2.1%), and dislocation (1.9%). Notably, patients with osteoporosis experienced more periprosthetic fractures. A high ASA score was significantly associated with an increased risk of postoperative complications and adverse outcomes (p = 0.002), including a higher likelihood of revision surgery. A significant effect of BMI on periprosthetic joint infection (PJI) was observed (OR = 1.10 [1.01–1.19], p = 0.023). In addition, older age significantly increased the risk of PJI (OR = 1.07 [1.00–1.15], p = 0.045). No significant differences in dislocation or infection rates were found when comparing different surgical approaches.

Discussion and conclusion: Although dual-mobility cups can reduce the incidence of dislocation in revision THA, they do not provide absolute prophylaxis, as the risk is still influenced by patient characteristics, surgical technique, and postoperative management. Cardiovascular comorbidities, higher BMI, and advanced age were associated with an increased risk of revision, whereas patients with renal insufficiency showed a tendency toward higher complication rates. These findings highlight the importance of individualized patient assessment and careful perioperative management when using DMCs in revision THA.