In this study, we examined the impact of dual-mobility (DM) versus fixed-bearing (FB) implants on outcomes following total hip arthroplasty (THA), a common and successful operation. We examined all-cause revision, revision due to dislocation, postoperative complications and functional scores in patients undergoing primary and revision THA.

A systematic review was performed according to PRISMA guidelines, and was registered in PROSPERO (ID CRD42023403736). The Cochrane Library, Embase, MEDLINE, Web of Science, and Scopus were searched from inception to 12th March 2023. Eligible studies underwent meta-analysis and methodological assessment using the ROBINS-I tool. Data were pooled using a random-effects maximum-likelihood model.

Eight comparative, non-randomised studies involving 2,810 DM implants and 3,188 FB implants were included. In primary THA, the difference in all-cause revision was imprecise (OR 0.82, 95% CI 0.25–2.72), whilst the DM cohort had a statistically significant benefit in revision due to dislocation (OR 0.08, 95% CI 0.02–0.28). In revision THA, the DM cohort showed significant benefit in all-cause revision (OR 0.57, 95% CI 0.31–1.05) and revision due to dislocation (OR 0.14, 95% CI 0.04–0.53). DM implants were associated with a lower incidence of implant dislocation and infection. Functional outcome analysis was limited due to underreporting. No intraprosthetic dislocations were observed.

The results suggest that contemporary DM designs may be advantageous in reducing the risk of all-cause revision, revision due to dislocation, and postoperative complication incidence at mid-term follow-up. Further high-quality prospective studies are needed to evaluate the long-term performance of this design, especially in revision cases.

Surgical trainees are finding it increasingly more challenging to meet operative requirements and coupled with the effects of COVID-19, we face a future of insufficiently trained surgeons. As a result, virtual reality (VR) simulator training has become more prevalent and whilst more readily accepted in certain arthroscopic fields, its use in hip arthroscopy (HA) remains novel. This project aimed to validate VR high-fidelity HA simulation and assess its functional use in arthroscopic training.

Seventy-two participants were recruited to perform two basic arthroscopic tasks on a VR HA simulator, testing hip anatomy, scope manipulation and triangulation skills. They were stratified into novice (39) and experienced (33) groups based on previous arthroscopy experience. Metric parameters recorded from the simulator were used to assess construct validity. Face validity was evaluated using a Likert-style questionnaire. All recordings were reviewed by 2 HA experts for blinded ASSET score assessment.

Experienced participants were significantly faster in completing both tasks compared with novice participants (p<0.001). Experienced participants damaged the acetabular and femoral cartilage significantly less than novice participants (p=0.011) and were found to have significantly reduced path length of both camera and instrument across both tasks (p=0.001, p=0.007), demonstrating significantly greater movement economy. Total ASSET scores were significantly greater in experienced participants compared to novice participants (p=0.041) with excellent correlation between task time, cartilage damage, camera and instrument path length and corresponding ASSET score constituents. 62.5% of experienced participants reported a high degree of realism in all facets of external, technical and haptic experience with 94.4% advising further practice would improve their arthroscopic skills. There was a relative improvement of 43% in skill amongst all participants between task 1 and 2 (p<0.001).

This is the largest study to date validating the use of simulation in HA training. These results confirm significant construct and face validity, excellent agreement between objective measures and ASSET scores, significant improvement in skill with continued use and recommend VR simulation to be a valuable asset in HA training for all grades.