Outcomes of total hip arthroplasty using dual mobility components in patients with a femoral neck fracture

Abstract

Aims Dislocation is the most common indication for further surgery following total hip arthroplasty (THA) when undertaken in patients with a femoral neck fracture. This study aimed to assess the complication rates of THA with dual mobility components (THA-DMC) following a femoral neck fracture and to compare outcomes between THA-DMC, conventional THA, and hemiarthroplasty (HA). Methods We performed a systematic review of all English language articles on THA-DMC published between 2010 and 2019 in the MEDLINE, EMBASE, and Cochrane databases. After the application of rigorous inclusion and exclusion criteria, 23 studies dealing with patients who underwent treatment for a femoral neck fracture using THA-DMC were analyzed for the rate of dislocation. Secondary outcomes included reoperation, periprosthetic fracture, infection, mortality, and functional outcome. The review included 7,189 patients with a mean age of 77.8 years (66.4 to 87.6) and a mean follow-up of 30.9 months (9.0 to 68.0). Results THA-DMC was associated with a significantly lower dislocation rate compared with both THA (OR 0.26; 95% CI 0.08 to 0.79) and HA (odds ratio (OR) 0.27; 95% confidence interval (CI) 0.15 to 0.50). The rate of large articulations and of intraprosthetic dislocation was 1.5% (n = 105) and 0.04% (n = 3) respectively. Conclusion THA-DMC when used in patients with a femoral neck fracture is associated with a lower dislocation rate compared with conventional arthroplasty options. There was no increase in the rates of other complication when THA-DMC was used. Future cost analysis and prospective, comparative studies are required to assess the potential benefit of using THA-DMC in these patients. Cite this article: Bone Joint J 2020;102-B(7):811–821.

Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants

“…This risk could be related to different predisposing conditions observed in FNF patients, such as a good preoperative hip ROM, the prevalence of recurrent falls in older patients or the frequent postoperative delirium that compromises adherence to rehabilitation programs [ 29 , 30 ]. This increased risk is further confirmed by some systematic reviews: the authors of [ 31 ] reported that DMC THA is associated with a significantly lower dislocation rate compared with conventional THA (OR 0.26; 95% CI, 0.08 to 0.79); this was also confirmed by Romagnoli M. et al [ 32 ], who showed a slight significant risk ratio of 0.16 (95% CI, 0.09, 0.28; I 2 = 0%, p -value < 0.00001), with a statistically significant difference between the two groups.…”

Superior functional outcome with dual mobility THR as compared to conventional THR in fracture neck femur: a prospective cohort study

“…Literature [27][28][29][30] has shown the superiority of DMTHR for fracture neck of femur in reducing dislocation rates and requirement of Revision arthroplasty compared to conventional THR. However, studies that have assessed the difference in functional outcome between the two implant designs are lacking.…”

Orthogeriatric Care: Reviewing Improvements in Outcomes

“…Dual mobility components offer a possible solution to cases with high risk of dislocation. A systematic review of 23 studies showed that arthroplasties with dual mobility cups had significantly lower dislocation rates than patients treated with conventional THA (OR 0.26; 95%CI: 0.08 to 0.79) and hemiarthroplasty (OR 0.27; 95% 0.15 to 0.50), without increasing other complications [177]. Future prospective studies like the DUALITY register-based randomized controlled trial [178] and cost-analysis and studies are required to fully assess the potential benefit of this type of arthroplasty.…”