{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T03:45:12Z","timestamp":1783482312246,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T00:00:00Z","timestamp":1587945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Materials"],"abstract":"<jats:p>Revision of large-diameter, monoblock acetabular components for both hip resurfacing arthroplasty and metal-on-metal (MoM) total hip arthroplasty (THA) is correlated to a high amount of complications. For this reason, performing a limited revision by conversion to a dual mobility (DM) without acetabular component exchange has been proposed in order to limit these complications. Although DM bearing offers an easy solution avoiding the intraoperative and time-associated complications, concern about polyethylene wear and stability remains due to the difference regarding the design, the coverage angle and the clearance of the two implants. In order to evaluate the performance of this new solution with the new material to prevent the possibility of failure it is essential to conduct a review of the literature A qualitative systematic review of the literature has been conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, EMBASE, Google Scholar, and Scopus for English and French articles between January 2000 and October 2019 was performed, with the primary objective of finding articles about dual mobility bearing coupling with large metal-on-metal cup in the case of hip revision procedure. Various combinations of the key words were used in the search strategy. Thirteen articles with DM bearing mated with MoM cup were analyzed. Of the 130 hip revisions selected, with a follow-up from 6 to 53 months, there were a total of 14 with complications (10.77%): four true dislocations (3.08%); six intra-prosthetic dislocations (IPD, 4.6%), two of which presented plastic deformation and polyethylene wear; four other complications (3.08%), included a cup osteolysis, a clicking noise, a superficial infection and a periprosthetic fracture. All the mentioned true dislocations occurred during the first month while IPDs appeared during the first two years from the index revision. In conclusion, according to the literature analyzed, we can stress that the concerns and doubts about mating a DM bearing with large MoM cup cannot be dissolved. It has been pointed out that a DM bearing is not designed for a MoM cup; it is not mechanically tested on MoM cups, which presents different clearance and coverage angles. Predictable complications may occur, such as IPD, polyethylene wear and true dislocation. These complications have been reported at an even higher rate than they were in the eighties, when the first generation of DM implants were of a lower quality of polyethylene and the characteristic of the design was less optimal than modern ones.<\/jats:p>","DOI":"10.3390\/ma13092040","type":"journal-article","created":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T10:30:58Z","timestamp":1588069858000},"page":"2040","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3615-6085","authenticated-orcid":false,"given":"Saverio","family":"Affatato","sequence":"first","affiliation":[{"name":"Laboratorio di Tecnologia Medica, IRCCS \u2013 Istituto Ortopedico Rizzoli, 40100 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Castiello","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Ortopedia e Traumatologia, Ospedale Maggiore, 40100 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Amendola","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Ortopedia e Traumatologia, Ospedale Maggiore, 40100 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio","family":"Comitini","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Ortopedia e Traumatologia, Ospedale Maggiore, 40100 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Louis","family":"Prudhon","sequence":"additional","affiliation":[{"name":"Centre Osteo-Articulaire Echirolles, 38100 Grenoble, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Tigani","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa di Ortopedia e Traumatologia, Ospedale Maggiore, 40100 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/s00264-010-1148-8","article-title":"Indications and results of hip resurfacing","volume":"35","author":"McMINN","year":"2010","journal-title":"Int. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"August, A., Aldam, C., and Pynsent, P. (1986). The McKee-Farrar hip arthroplasty. A long-term study. J. Bone Jt. Surgery. Br., 520\u2013527.","DOI":"10.1302\/0301-620X.68B4.3733823"},{"key":"ref_3","first-page":"7","article-title":"Total Hip Replacement by Low-Friction Arthroplasty","volume":"72","author":"Charnley","year":"1970","journal-title":"Clin. Orthop."},{"key":"ref_4","first-page":"229","article-title":"Arthroplastie totale de la hanche par proth\u00e8se en alumine fritt\u00e9e. \u00c9tude exp\u00e9rimentale et premi\u00e8res applications cliniques","volume":"58","author":"Boutin","year":"1972","journal-title":"Rev. Chir. Orthop. Reparatrice Appar. Mot."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/01.blo.0000246561.73338.68","article-title":"Larger Diameter Bearings Reduce Wear in Metal-on-Metal Hip Implants","volume":"456","author":"Affatato","year":"2007","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1302\/0301-620X.86B2.14600","article-title":"Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis","volume":"86","author":"Daniel","year":"2004","journal-title":"J. Bone Jt. Surgery. Br."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1302\/2058-5241.4.180078","article-title":"MoM total hip replacements in Europe: A NORE report","volume":"4","author":"Pijls","year":"2019","journal-title":"EFORT Open Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/j.arth.2012.01.019","article-title":"Large-diameter modular metal-on-metal total hip arthroplasty: Incidence of revision for adverse reaction to metallic debris","volume":"27","author":"Barrett","year":"2012","journal-title":"J. Arthroplast."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1302\/0301-620X.94B6.29239","article-title":"Independent predictors of revision following metal-on-metal hip resurfacing: A retrospective cohort study using National Joint Registry data","volume":"94","author":"Jameson","year":"2012","journal-title":"J. Bone Jt. Surgery. Br."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1016\/j.arth.2015.03.009","article-title":"Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective","volume":"30","author":"Matharu","year":"2015","journal-title":"J. Arthroplast."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1007\/s00402-014-2005-9","article-title":"MRI does not detect acetabular osteolysis around metal-on-metal Birmingham THA","volume":"134","author":"Waldstein","year":"2014","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s00402-016-2439-3","article-title":"Cobalt serum levels differ in well functioning Birmingham resurfacing and Birmingham modular THA","volume":"136","author":"Renner","year":"2016","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kasparek, M.F., Renner, L., Faschingbauer, M., Waldstein, W., Rueckl, K., and Boettner, F. (2017). Salvage of a monoblock metal-on-metal cup using a dual mobility liner: A two-year MRI follow-up study. Int. Orthop., 42.","DOI":"10.1007\/s00264-017-3641-9"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1007\/s11999-013-2979-6","article-title":"High Complication Rate After Revision of Large-head Metal-on-metal Total Hip Arthroplasty","volume":"472","author":"Munro","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"McPherson, F.E., and Sherif, S. (2012). In Vivo Dissociation of A Dual Articulation Bearing in Revision THA\u2013Case Report. Reconstr. Rev., 2.","DOI":"10.15438\/rr.v2i2.18"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1016\/j.arth.2012.05.012","article-title":"Revising the Well-Fixed, Painful Resurfacing Using a Double-Mobility Head. A New Strategy to Address Metal-on-Metal Complications","volume":"27","author":"Verhelst","year":"2012","journal-title":"J. Arthroplast."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.2106\/JBJS.CC.L.00222","article-title":"Early Failure of Metal-on-Metal Large-Diameter Head Total Hip Arthroplasty Revised with a Dual-Mobility Bearing","volume":"3","author":"Riviere","year":"2013","journal-title":"JBJS Case Connect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.arth.2013.04.011","article-title":"One-Component Revision of Failed Hip Resurfacing from Adverse Reaction to Metal Wear Debris","volume":"29","author":"Pritchett","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"369","DOI":"10.3928\/01477447-20150603-04","article-title":"Revision of Failed Hip Resurfacing and Large Metal-on-Metal Total Hip Arthroplasty Using Dual-Mobility Components","volume":"38","author":"Snir","year":"2015","journal-title":"Orthopedics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.arth.2015.08.016","article-title":"Salvage of Monoblock Metal-on-Metal Acetabular Components Using a Dual-Mobility Bearing","volume":"31","author":"Plummer","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1302\/0301-620X.98B6.36908","article-title":"Pseudotumour formation and subsequent resolution in metal-on-metal total hip arthroplasty following revision","volume":"98","author":"Sassoon","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"512","DOI":"10.2174\/1874325001610010512","article-title":"Revision of Metal-on-metal Hip Arthroplasty with Well Fixed and Positioned Acetabular Component Using a Dual-mobility Head and Review of Literature","volume":"10","author":"Coll","year":"2016","journal-title":"Open Orthop. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e980","DOI":"10.3928\/01477447-20160526-06","article-title":"Acute Disassembly and Dissociation of a Dual-Mobility Next-Generation Prosthesis","volume":"39","author":"Samona","year":"2016","journal-title":"Orthopedics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.artd.2018.03.004","article-title":"Catastrophic failure of a dual mobility bearing in a revision total hip arthroplasty","volume":"4","author":"Brazier","year":"2018","journal-title":"Arthroplast. Today"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1016\/j.arth.2019.04.065","article-title":"Conversion of Hip Resurfacing with Retention of Monoblock Acetabular Shell Using Dual-Mobility Components","volume":"34","author":"Blevins","year":"2019","journal-title":"J. Arthroplast."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.arth.2019.09.028","article-title":"Dual Mobility for Monoblock Metal-on-Metal Revision\u2014Is It Safe?","volume":"35","author":"Colacchio","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0035-1040(04)70101-4","article-title":"[Intra-prosthetic dislocation of the Bousquet dual mobility socket]","volume":"90","author":"Lecuire","year":"2004","journal-title":"Rev. Chir. Orthop. Reparatrice Appar. Mot."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_29","unstructured":"(2011, April 26). Zimmer Biomet. Available online: www.ww.biomet.com."},{"key":"ref_30","unstructured":"(2020, March 05). European Medicines Agency. Available online: https:\/\/www.ema.europa.eu\/en\/human-regulatory\/overview\/medical-devices."},{"key":"ref_31","unstructured":"(2018). Le paradoxe de la double mobilit\u00e9: Mobilit\u00e9 et stabilit\u00e9. La double mobilit\u00e9 en marchedans les proth\u00e8ses Total hanche, Elsevier."},{"key":"ref_32","unstructured":"(2018). Cupule double mobilit\u00e9\u2014De la casquette \u00e0 la forme cylindrospherique. La double mobilit\u00e9 en marchedans les proth\u00e8ses Total hanche, Elsevier."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.arth.2013.12.011","article-title":"Are Modern Dual Mobility Cups a Valuable Option in Reducing Instability After Primary Hip Arthroplasty, Even in Younger Patients?","volume":"29","author":"Epinette","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1302\/0301-620X.90B9.20785","article-title":"The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip","volume":"90","author":"Langton","year":"2008","journal-title":"J. Bone Jt. Surgery. Br."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"De Smet, K., Campbell, P.N., and Van Der Straeten, C. (2013). Design issues and comparison of hip resurfacing prostheses. The Hip Resurfacing Handbook, Woodhead Publishing Series in Biomaterials. A practical guide to the use and management of modern hip resurfacings.","DOI":"10.1533\/9780857096203"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s11999-012-2559-1","article-title":"What factors affect posterior dislocation distance in THA?","volume":"471","author":"Nevelos","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1007\/s11999-014-3469-1","article-title":"Does Dual-mobility Cup Geometry Affect Posterior Horizontal Dislocation Distance?","volume":"472","author":"Heffernan","year":"2014","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s00264-017-3696-7","article-title":"Letter to the editor on dislocations after use of dual-mobility cups in cementless primary total hip arthroplasty: Prospective multicenter series by Hwang et al","volume":"42","author":"Viste","year":"2018","journal-title":"Int. Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"131","DOI":"10.21037\/atm.2016.03.39","article-title":"Quantification of clearance and creep in acetabular wear measurements","volume":"4","author":"Saffarini","year":"2016","journal-title":"Ann. Transl. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1007\/s00402-015-2256-0","article-title":"Is there a rationale to use a dual mobility poly insert for failed Birmingham metal-on-metal hip replacements? A retrieval analysis","volume":"135","author":"Renner","year":"2015","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Underwood, R.J., Zografos, A., Sayles, R.S., Hart, A., and Cann, P. (2012). Edge Loading in Metal-on-Metal Hips: Low Clearance is a New Risk Factor, Proc Inst Mech Eng H. SAGE Publications.","DOI":"10.1177\/0954411911431397"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s11999-013-3399-3","article-title":"Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings","volume":"472","author":"Clarke","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3782","DOI":"10.1016\/j.arth.2017.06.044","article-title":"Microstructure and Surface Damage in Retrieved Metal-on-Metal Hip Arthroplasties","volume":"32","author":"Punset","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1016\/j.arth.2017.10.036","article-title":"Damage Assessment of Retrieved Birmingham Monoblock Cups: Is Conversion to Dual-Mobility Head a Viable Revision Option?","volume":"33","author":"Gascoyne","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1016\/j.arth.2017.12.044","article-title":"Retrieval Analysis of Large-Head Modular Metal-on-Metal Hip Replacements of a Single Design","volume":"33","author":"Gascoyne","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s11999-012-2639-2","article-title":"Intraprosthetic Dislocation: A Specific Complication of the Dual-mobility System","volume":"471","author":"Philippot","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_47","first-page":"20","article-title":"La trosieme articulation des proth\u00e8se de hanche a double mobilite","volume":"121","author":"Noyer","year":"2003","journal-title":"Ma\u00ectrise Orthop\u00e9dique"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.artd.2020.01.002","article-title":"Letter to the editor on \u201cAsymptomatic intraprosthetic dual mobility cup dislocation with increased metal ion levels\u201d","volume":"6","author":"Castiello","year":"2020","journal-title":"Arthroplast. Today"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1007\/s11999-011-2213-3","article-title":"Fixation Failures of Dual Mobility Cups: A Mid-term Study of 2601 Hip Replacements","volume":"470","author":"Massin","year":"2011","journal-title":"Clin. Orthop."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1007\/s00264-014-2313-2","article-title":"A comparative and retrospective study of three hundred and twenty primary Charnley type hip replacements with a minimum follow up of ten years to assess whether a dual mobility cup has a decreased dislocation risk","volume":"38","author":"Caton","year":"2014","journal-title":"Int. Orthop."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1007\/s00264-015-2985-2","article-title":"Prospective longitudinal study of one hundred patients with total hip arthroplasty using a second-generation cementless dual-mobility cup","volume":"39","author":"Vermersch","year":"2015","journal-title":"Int. Orthop."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.otsr.2013.07.017","article-title":"Evora\u00ae chromium\u2013cobalt dual mobility socket: Results at a minimum 10years\u2019 follow-up","volume":"99","author":"Leclercq","year":"2013","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s00264-016-3325-x","article-title":"Dual-mobility cup in total hip arthroplasty in patients less than fifty five years and over ten years of follow-up: A prospective and comparative series","volume":"41","author":"Puch","year":"2017","journal-title":"Int. Orthop."}],"container-title":["Materials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1996-1944\/13\/9\/2040\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:32:08Z","timestamp":1760362328000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1996-1944\/13\/9\/2040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,27]]},"references-count":53,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["ma13092040"],"URL":"https:\/\/doi.org\/10.3390\/ma13092040","relation":{},"ISSN":["1996-1944"],"issn-type":[{"value":"1996-1944","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,27]]}}}