Dual mobility total hip arthroplasty in the treatment of femoral neck fractures

Abstract

Aims To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA). Methods Studies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA. Results A total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z −4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z −3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z −4.2). Conclusion While the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA. Cite this article: Bone Joint J 2020;102-B(11):1457–1466.

Instability after hip hemiarthroplasty for femoral neck fracture: an unresolved problem

“…Consideration of dual mobility or constrained liner in patients with dementia who cannot follow postoperative instructions is also recommended. [24][25][26]…”

Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease

“…35,36 Our findings of similar dislocation rates after DMC-THA compared with HA, are at odds with the small clinical studies and the pooled meta-analysis on patients with a fracture of the hip with or without neurological disease, comparing the dislocation rate between HA and DMC-THA. 20,37 A register study from the Nordic countries showed a reduced risk of revision with DMC-THA as treatment for a fracture, compared with cTHA, with the limitation of not having comorbidity data to adjust for, and without information about neurological diseases. 18 The place of DMC-THAs in the treatment of patients with a fracture is nowadays clear, though it is not a 'magic bullet', as illustrated by our finding of a similar risk of revision and reoperation as cTHA and HA in our high-risk group of patients.…”

“…[8][9][10][11][12][13] In patients with a femoral neck fracture, the use of dualmobility components (DMC-THA) has increased at the expense of conventional THA (cTHA), although observational studies have suggested that this type of implant confers a reduced risk of dislocation. [14][15][16][17][18][19][20] While the importance of the size of the femoral head has been well described in elective primary THA, it has been less well described in arthroplasty for fractures of the hip. [21][22][23][24] It has been shown that the posterior approach is associated with a higher risk of dislocation.…”

Total Hip Arthroplasty for Hip Fracture: Clinical Results and Mid-Term Survivorship

“…Coomber et al published a review of the evi­dence on technique for performing THA for hip fracture and recommend the use of larger head sizes (32 mm to 36 mm) [ 21 ]. Dual mobility components have been shown to reduce the risk of dislocation further in patients with a femoral neck fracture [ 22 ].…”