DUAL MOBILITY CUPS REDUCE DISLOCATION RATE IN TOTAL HIP ARTHROPLASTY FOR DISPLACED FEMORAL NECK FRACTURES

Abstract Background: Displaced femoral neck fractures (DFNF) are increasingly common in elderly patients. Repair of DFNF can be completed using two methods, hemiarthroplasty (HA) or total hip Arthroplasty (THA). However, there is much controversy regarding whether HA or THA is superior in active elderly patients over 75 years old. Methods: We conducted the literature search by searching PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, and Web of Science from the inception dates to June 1, 2019. Randomised controlled trials (RCT) were included according to the inclusion and exclusion criteria. Included studies were analysed according to Cochrane review methods. Results: Nine studies met the inclusion criteria totalling 631 participants (301 THA and 330 HA）. Four of the studies conducted were identical to a previous study but look at different follow up measures. The analysis of previously collected data revealed that the THA group had a lower erosion rate, higher total pain and function HHS, and higher EQ-5Dindex. The re-operation rate was significantly lower in the THA group after five years of follow up after adding the patients with painful symptoms to the group of patients revised. However, THA had longer operative time and a higher dislocation rate in the first three years compared to the HA procedure. Moreover, there was an insignificant difference in mortality rate, general complications, wound infection, duration of hospital stay, and VTE prevalence among the two procedures. Conclusions: THA may be a preferred management option for active elderly patients over 75 years old, after careful evaluation of patients’ general condition and tolerance of surgery. Strict management and follow up protocols should be followed to prevent dislocation within the first three years following a THA. Trial registration: This study was registered at the International Prospective Register of Systematic Reviews (CRD42019139135). The date of registration is 16-06-2019. Keywords: displaced femoral neck fractures; total hip arthroplasty; hemiarthroplasty;

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Dual mobility in primary total hip arthroplasty: current concepts

EFORT Open Reviews ◽

10.1302/2058-5241.4.180089 ◽

2019 ◽

Vol 4 (11) ◽

pp. 640-646 ◽

Cited By ~ 5

Author(s):

Rory Cuthbert ◽

James Wong ◽

Philip Mitchell ◽

Parag Kumar Jaiswal

Keyword(s):

High Risk ◽

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

High Risk Patient ◽

Femoral Neck Fractures ◽

Risk Patient ◽

Functional Improvement ◽

Dual Mobility ◽

Total Hip

Total hip arthroplasty (THA) is one of the most successful surgical procedures – reducing pain and providing functional improvement. However, THA instability is a disabling condition and remains the most common indication for revision THA. To combat the risk of instability, the concept of dual mobility (DM) was developed. This article provides a comprehensive review of DM in the literature. Widespread use of first-generation DM was limited due to concern regarding wear of the polyethylene head and the unique complication of intraprosthetic dislocation (IPD). Implant modifications using highly cross-linked, durable polyethylene and a smooth, cylindrical femoral neck have all but eliminated IPD in contemporary DM. In multiple studies, DM demonstrates statistically significant reductions in dislocation rates comparative to standard bearing primary THA. These results have been particular promising in high-risk patient populations and femoral neck fractures – where low dislocation rates and improved functional outcomes are a recurrent theme. From an economic perspective, DM is equally exciting – with lower accrued costs and higher accrued utility comparative to standard bearing THA. Longer-term clinical evidence and higher-quality prospective comparative studies are required to strengthen current research. Dual mobility may well represent the future gold standard for THA in high-risk patient populations and femoral neck fractures, but due diligence of long-term performance is needed before recommendations for widespread use can be justified. Cite this article: EFORT Open Rev 2019;4:640-646. DOI: 10.1302/2058-5241.4.180089

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

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-1486.r1 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 811-821 ◽

Cited By ~ 2

Author(s):

Daniel You ◽

Aresh Sepehri ◽

Sahil Kooner ◽

Halli Krzyzaniak ◽

Herman Johal ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hip Arthroplasty ◽

Dislocation Rate ◽

Complication Rates ◽

Dual Mobility ◽

Total Hip ◽

Neck Fracture ◽

Lower Dislocation Rate

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.

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