Femoral neck fractures (FNFs), with up to 15% mortality, are prominent orthopaedic emergencies. After treating FNFs, dislocation is another challenge increasing morbidity, mortality and treatment costs substantially. The emerging dual-mobility cup (DMC) may decrease dislocation rates following total hip arthroplasty (THA) for FNFs. We performed a systematic review of literature reporting dislocation and mortality rates with DMC-THA for the treatment of FNFs.
Methods:
2 authors independently searched PubMed (MEDLINE), Google Scholar and Cochrane library for studies reporting dislocation and mortality rates for FNFs treated with DMC-THA since inception up to January 2019. Data on outcomes of interest was extracted from all studies and assessed for eligibility for a meta-analysis.
Results:
Out of 522 search results, 18 studies were included in the systematic review and 4 in the meta-analysis. The mean rate of dislocation following DMC-THA for FNFs was found to be 1.87% ± 2.11, with a 1-year mortality rate of 14.0% ± 10.55. Results of meta-analysis showed that dislocation and 1-year postoperative mortality rates were significantly lower for DMC-THA with a risk ratio 0.31 (95% CI, 0.16–0.59; I2 = 0%, p= 0.0003) and 0.55 (0.40, 0.77; I2 = 0%, p = 0.003) respectively when compared to biploar hemiathroplasty (BHA).
Conclusions:
The mean dislocation and mortality rates in DMC-THA are lower than previously reported rates for THA with single cup and comparable to unipolar and bipolar hemiarthroplasty. Further research involving randomised control trials to assess differences in outcomes, longevity and cost-effectiveness needs to be conducted to make recommendations for the use of DMC in treating FNFs.
RiggsBLMeltonLJ3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone1995; 17(Suppl. 5): 505S–511S.
2.
KannusPParkkariJSievänenH, et al. Epidemiology of hip fractures. Bone1996; 18(Suppl. 1): 57S–63S.
3.
YoonBHLeeYKKimSC, et al. Epidemiology of proximal femoral fractures in South Korea. Arch Osteoporos2013; 8: 157.
4.
KeeneGSParkerMJPryorGA. Mortality and morbidity after hip fractures. BMJ1993; 307: 1248–1250.
5.
BentlerSELiuLObrizanM, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol2009; 170: 1290–1299.
6.
WhiteSMGriffithsR. Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury2011; 42: 1230–1233.
7.
BurgersPTVan GeeneARVan den BekeromMP, et al. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop2012; 36: 1549–1560.
8.
BelmontPJJrGarciaEJRomanoD, et al. Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg2014; 134: 597–604.
9.
JiangJYangCHLinQ, et al. Does arthroplasty provide better outcomes than internal fixation at mid-and long-term followup? A meta-analysis. Clin Orthop Relat Res2015; 473: 2672–2679.
10.
YuLWangYChenJ. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res2012; 470: 2235–2243.
11.
IorioRHealyWLLemosDW, et al. Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clin Orthop Relat Res2001; 383: 229–242.
12.
ConroyJLWhitehouseSLGravesSE, et al. Risk factors for revision for early dislocation in total hip arthroplasty. J Arthroplasty2008; 23: 867–872.
13.
PoignardABouhouMPidetO, et al. High dislocation cumulative risk in THA versus hemiarthroplasty for fractures. Clin Orthop Relat Res2011; 469: 3148–3153.
14.
HailerNPWeissRJStarkA, et al. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis: an analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthop2012; 83: 442–448.
15.
RavikumarKJMarshG. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur—13 year results of a prospective randomised study. Injury2000; 31: 793–797.
16.
Sanchez-SoteloJHaidukewychGJBobergCJ. Hospital cost of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am2006; 88: 290–294.
17.
JohanssonTBachrach-LindströmMAspenbergP, et al. The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. Int Orthop2006; 30: 1–6.
18.
Lu-YaoGLKellerRBLittenbergB, et al. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am2005; 76: 15–25.
19.
TaraseviciusSBuseviciusMRobertssonO, et al. Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture. BMC Musculoskelet Disord2010; 11: 175.
20.
AdamPPhilippeREhlingerM, et al. Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Orthop Traumatol Surg Res2012; 98: 296–300.
21.
BensenASJakobsenTKrarupN. Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures. Int Orthop2014; 38: 1241–1245.
22.
PhilippotRBoyerBFarizonF. Intraprosthetic dislocation: a specific complication of the dual-mobility system. Clin Orthop Relat Res2013; 471: 965–970.
23.
NeriTBoyerBGeringerJ, et al. Intraprosthetic dislocation of dual mobility total hip arthroplasty: still occurring?Int Orthop2018; 42: 2733.
24.
LaurendonLPhilippotRNeriT, et al. Ten-year clinical and radiological outcomes of 100 total hip arthroplasty cases with a modern cementless dual mobility cup. Surgl Technol Int2018; 32: 331–336.
25.
MoherDLiberatiATetzlaffJ, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med2009; 6: e1000097.
26.
LiberatiAAltmanDGTetzlaffJ, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med2009; 6: e1000100.
27.
SheaBJGrimshawJMWellsGA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol2007; 7: 10.
28.
VissersMMBussmannJBVerhaarJA, et al. Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum2012: 41; 576–588.
29.
GraversenAEJakobsenSSKristensenPK, et al. No dislocations after primary hip arthroplasty with the dual mobility cup in displaced femoral neck fracture in patients with dementia. A one-year follow-up in 20 patients. SICOT J2017; 3: 9.
30.
HenawyATAbdel BadieA. Dual mobility total hip arthroplasty in hemiplegic patients. SICOTJ2017; 3: 40.
31.
NichCVandenbusscheEAugereauB, et al. Do dual-mobility cups reduce the risk of dislocation in total hip arthroplasty for fractured neck of femur in patients aged older than 75 years?J Arthroplasty2016; 31: 1256–1260.
32.
AndersenMFJakobsenTBensenAS, et al. Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture. Sicot J2015; 1: 26.
33.
TaraseviciusSRobertssonODobozinskasP, et al. A comparison of outcomes and dislocation rates using dual articulation cups and THA for intracapsular femoral neck fractures. Hip Int2013; 23: 22–26.
34.
HommaYBabaTOzakiY, et al. In total hip arthroplasty via the direct anterior approach, a dual-mobility cup prevents dislocation as effectively in hip fracture as in osteoarthritis. Int Orthop2017; 41: 491–497.
35.
KimYTYooJHKimMK, et al. Dual mobility hip arthroplasty provides better outcomes compared to hemiarthroplasty for displaced femoral neck fractures: a retrospective comparative clinical study. Int Orthop2018; 42: 1241–1246.
36.
OchiHBabaTHommaY, et al. Total hip arthroplasty via the direct anterior approach with a dual mobility cup for displaced femoral neck fracture in patients with a high risk of dislocation. SICOT J2017; 3: 56.
37.
BoukebousBBoutrouxPZahiR, et al. Comparison of dual mobility total hip arthroplasty and bipolar arthroplasty for femoral neck fractures: a retrospective case-control study of 199 hips. Orthop Traumatol Surg Res2018; 104: 369–375.
38.
RashedRASevenoaksHShabaanAM, et al. Functional outcome and health related quality of life after dual mobility cup total hip replacement for displaced femoral neck fractures in middle aged Egyptian patients. Injury2018; 49: 667–672.
39.
AssiCCBarakatHBCatonJG, et al. Mortality rate and mid-term outcomes of total hip arthroplasty using dual mobility cups for the treatment of femoral neck fractures in a Middle Eastern population. J Arthroplasty2019; 34: 333–337.
40.
Tabori-JensenSHansenTBStillingM. Low dislocation rate of Saturne®/Avantage® dual-mobility THA after displaced femoral neck fracture: a cohort study of 966 hips with a minimum 1.6-year follow-up. Arch Orthop Trauma Surg2019; 139: 605–612.
41.
Tabori-JensenSHansenTBBøvlingS, et al. Good function and high patient satisfaction at mean 2.8 years after dual mobility THA following femoral neck fracture: a cross-sectional study of 124 patients. Clin Interv Aging2018; 13: 615–621.
42.
HwangJHKimSMOhKJ, et al. Dislocations after use of dual-mobility cups in cementless primary total hip arthroplasty: prospective multicentre series. Int Orthop2018; 42: 761–767.
43.
ZagorovMMihovKDobrilovS, et al. Dual mobility cups reduce dislocation rate in total hip arthroplasty for displaced femoral neck fractures. J of IMAB2018; 24: 2077–2081.
44.
DarrithBCourtneyPMDella-ValleCJ. Outcomes of dual mobility components in total hip arthroplasty: a systematic review of the literature. Bone Joint J2018; 100–B: 11–19.
45.
FarizonFde LavisonRAzoulaiJJ, et al. Results with a cementless alumina-coated cup with dual mobility. Int Orthop1998; 22: 219–224.
46.
PaternoSALachiewiczPFKelleySS. The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. J Bone Joint Surg Am1997; 79: 1202–1210.
47.
HedlundhUFredinH. Patient characteristics in dislocations after primary total hip arthroplasty: 60 patients compared with a control group. Acta Orthop Scand1995; 66: 225–228.
48.
DelaunayCHamadoucheMGirardJ, et al. What are the causes for failures of primary hip arthroplasties in France?Clin Orthop Relat Res2013; 471: 3863–3869.
49.
JohnellOKanisJA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporosis Int2004; 15: 897–902.
50.
GuyenO. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures?Orthop Traumatol Surg Res2019; 105: S95–S101.
51.
AdamsJDJrCristBD. Hip arthroplasty in femoral neck fractures. In: BorrelliJAnglenJO (eds) Arthroplasty for the treatment of fractures in the older patient: indications and current techniques. Switzerland: Springer International Publishing, 2018, pp.165–181.
52.
LiaoLZhaoJmSuW, et al. A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures. Arch Orthop Trauma Surg2012; 132: 1021–1029.
53.
NewingtonDPBannisterGCFordyceM. Primary total hip replacement in patients over 80 years of age. J Bone Joint Surg Br1990; 72: 450–452.
54.
WoolsonSTRahimtoolaZO. Risk factors for dislocation during the first 3 months after primary total hip replacement. J Arthroplasty1999; 14: 662–668.
55.
PadgettDEWarashinaH. The unstable total hip replacement. Clin Orthop Relat Res2004; 420: 72–79.
56.
PatelPDPottsAFroimsonMI. The dislocating hip arthroplasty: prevention and treatment. J Arthroplasty2007(Suppl. 1); 22: 86–90.
57.
WernerBCBrownTE. Instability after total hip arthroplasty. World J Orthop2012; 3: 122–130.
58.
BourneRBMehinR. The dislocating hip: what to do, what to do. J Arthroplasty2004; 19: 111–114.
59.
FacklerCDPossR. Dislocation in total hip arthroplasties. Clin Orthop Relat Res1980; 151: 169–178.
60.
MertlPCombesALeiber-WackenheimF, et al. Recurrence of dislocation following total hip arthroplasty revision using dual mobility cups was rare in 180 hips followed over 7 years. HSS J2012; 8: 251–256.
61.
D’AngeloFMurenaLZattiG, et al. The unstable total hip replacement. Indian J Orthop2008; 42: 252–259.
62.
DobzyniakMFehringTKOdumS. Early failure in total hip arthroplasty. Clin Orthop Relat Res2006; 447: 76–78.
63.
MasonisJLBourneRB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res2002; 405: 46–53.
64.
PellicciPMBostromMPossR. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res1998; 355: 224–228.
65.
McLawhornASPotterHGCrossMB, et al. Posterior soft tissue repair after primary THA is durable at mid-term followup: a prospective MRI study. Clin Orthop Relat Res2015; 473: 3183–3189.
66.
MorreyBF. Instability after total hip arthroplasty. Orthop Clin North Am1992; 23: 237–248.
67.
SoongMRubashHEMacaulayW. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg2004; 12: 314–321.
68.
GuyenOChenQSBejui-HuguesJ, et al. Unconstrained tripolar hip implants: effect on hip stability. Clin Orthop Relat Res2007; 455: 202–208.
69.
HowieDWHolubowyczOTMiddletonR. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am2012; 94: 1095–1102.
70.
GarbuzDSMasriBADuncanCP, et al. The Frank Stinchfield award: dislocation in revision THA: do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial?Clin Orthop Relat Res2012; 470: 351–356.
71.
CrossMBNamDMaymanDJ. Ideal Femoral head size in total hip arthroplasty balances stability and volumetric wear. HSS J2012; 8: 270–274.
72.
LachiewiczPFHeckmanDSSoileauES, et al. Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years. 2009; 467: 3290–3296.
73.
McKeeGKWatson-FarrarJ. Replacement of arthritic hips by the McKee-Farrar prosthesis. J Bone Joint Surg Br1966; 48: 245–259.
74.
SimianEChatellardRDruonJ, et al. Dual mobility cup in revision total hip arthroplasty: dislocation rate and survival after 5 years. Orthop Traumatol Surg Res2015; 101: 577–581.
75.
BloemheuvelEMvan SteenbergenLNSwierstraBA. Dual mobility cups in primary total hip arthroplasties: trend over time in use, patient characteristics, and mid-term revision in 3,038 cases in the Dutch Arthroplasty Register (2007–2016). Acta Orthop2019; 90: 11–14.
76.
EpinetteJALafumaARobertJ, et al. Cost-effectiveness model comparing dual-mobility to fixed-bearing designs for total hip replacement in France. Orthop Traumatol Surg Res2016; 102: 143–148.
77.
BrytrömSEspehaugBFurnesO, et al. Femoral size is a risk factor for total hip dislocation (a study of 42987 primary THR from the Norwegian Arthroplasty Register). Acta Orthop Scand2003; 74: 514–524.
78.
PrudhonJLFerreiraAVerdierR. Dual mobility cup: dislocation rate and survivorship at ten years of follow-up. Int Orthop2013; 37: 2345–2350.
79.
LautridouCLebelBBurdinG, et al. Survival of the cementless Bousquet dual mobility cup: minimum 15-year follow-up of 437 total hip arthroplasties. Rev Chir Orthop Reparatrice Appar Mot2008; 94: 731–739.
80.
BartelsSGjertsenJEFrihagenF, et al. High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years. Acta Orthop2018; 89: 53–58.
81.
UhlerLMSchultzWRHillAD, et al. Health utility of early hemiarthroplasty vs delayed total hip arthroplasty for displaced femoral neck fracture in elderly patients: a Markov model. J Arthroplasty32; 1434–1438.
82.
MassinPOrainVPhilippotR, et al. Fixation failures of dual mobility cups: a mid-term study of 2601 hip replacements. Clin Orthop Relat Res2012; 470: 1932–1940.
