Dual Mobility Versus Conventional Total Hip Arthroplasty for Femoral Neck Fractures: A Systematic Review and...

Area of Science:

• Orthopedic Surgery
• Biomaterials Engineering
• Clinical Trials

Background:

• Dual mobility (DM) implants are increasingly used in hip arthroplasty for enhanced stability, particularly in revision cases and high-risk patients.
• Dislocation remains a significant concern in total hip replacement (THR), especially for complex cases like femoral neck fractures.
• Conventional total hip replacement (C-THR) has established outcomes, but newer designs like DM-THR are being evaluated for improved performance.

Purpose of the Study:

• To systematically review and meta-analyze the existing literature comparing dual mobility total hip replacement (DM-THR) with conventional total hip replacement (C-THR).
• To assess and compare the rates of dislocation and re-operation between DM-THR and C-THR specifically for patients with displaced femoral neck fractures.
• To evaluate the overall viability of DM-THR as an alternative to C-THR in this patient population.

Main Methods:

• A systematic literature search was conducted across PubMed, PsycINFO, Cochrane databases, and Google Scholar.
• Studies comparing DM-THR and C-THR for femoral neck fractures were identified following PRISMA guidelines.
• A meta-analysis was performed on data from nine selected studies involving 9,816 patients (7,197 C-THR, 2,619 DM-THR).

Main Results:

• The cumulative dislocation rate across all studies was 1.35%, with DM-THR showing a lower rate (0.8%) compared to C-THR (1.5%).
• The meta-analysis favoured DM-THR over C-THR regarding dislocation rates (P < 0.05, 95% CI).
• No significant difference was observed in cumulative re-operation rates between DM-THR (2.9%) and C-THR (3.87%).

Conclusions:

• Dual mobility total hip replacement (DM-THR) demonstrates a statistically significant reduction in dislocation rates compared to conventional total hip replacement (C-THR) for femoral neck fractures.
• While DM-THR did not show a significant difference in re-operation rates in this analysis, its improved stability is noteworthy.
• Further large-scale, high-quality randomized controlled trials with long-term follow-up and cost-effectiveness analyses are necessary to fully establish DM-THR as a preferred option for femoral neck fractures.