Outcomes of total hip arthroplasty using dual-mobility cups for femoral neck fractures: a systematic review and meta-analysis

Abstract

Objectives: 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.

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

“…Zagorov et al [34] in 2018 compared postoperative dislocation rate with Dual mobility cup with that of conventional THR and Bipolar Hemiarthroplasty for displaced femoral neck fractures and concluded that DMTHR had 0% dislocation rate as compared to 11.1% in conventional THR and 3.1% in bipolar hemiarthroplasty. Similar comparative studies in the literature [10,11,[27][28][29][30][31] have shown the superiority of DMTHR over conventional THR in terms of postoperative stability and requirement of revision arthroplasty and are enlisted in Table 3. In the present study, no difference was found between postoperative dislocation rate, postoperative stability, implant loosening, and rate of revision surgery between the two groups, as none of the patients had any such complication.…”

“…There is some evidence [31][32][33] in line with this finding. On the other hand, systematic review and metanalysis by Canton et al [27] and most of the literature on DMTHR [10,11,28,29,31,34] have either not been compared or have documented functional outcome equivalent to that with the conventional THR. The score was specifically better in activities sections like sitting crosslegged and squatting and in the motion section.…”

“…However, except a few [43,44], most of the literature evidence [2,[45][46][47] has shown that THR, with Charnley's principle of low friction arthroplasty, is significantly better than bipolar hemiarthroplasty in terms of long-term functional outcome. Hence, with a combination of these two principles, DMTHR would be an implant to offer the benefits of both [29].…”

“…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.…”

The Personal History of an Orthopedic Surgeon - Study Experiences That Changed My Life Orthopedic and Traumatology Training in France -

“…Orthopédie (SOFJO), was the president of SOFCOT in 2016, and he has also been appointed as the chairman for the 39th world congress of la Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) in Montreal.SOFJO introduces a large number of those aiming to study abroad to training facilities. Until March 2017, a total of 82 Japanese and 19 French trainees had studied in France and Japan23) , respectively. If you wish to study abroad, please access the SOFJO website.…”