JOA - 2026-03-24 - Journal Article
Dual Mobility versus Conventional Total Hip Arthroplasty for Femoral Neck Fractures: A Multicenter Propensity-Matched Study on Dislocation Risk.
Koh CK, Lee J, Young S, Monk P, Munro J, Lynch J, Beaule P, Grammatopoulos G
Topics
Key Takeaway
Dual mobility THA reduced 5-year dislocation incidence from 4.8% to 0.5% compared to conventional THA in femoral neck fracture patients without increasing overall revision rates.
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Summary
This multicenter retrospective propensity-matched study compared dislocation and revision incidence between DM-THA and conventional THA in 822 displaced femoral neck fracture patients across four hospitals from 2012–2020. After 2:1 propensity matching on age, sex, ASA score, surgical approach, and surgeon experience, DM-THA demonstrated a significantly lower 5-year dislocation rate (0.5% vs 4.8%, P=0.005). Revision for instability (0.5% vs 2.0%, P=0.2) and all-cause revision (3.1% vs 3.9%, P=0.3) did not differ significantly between groups.
Key Limitation
The absence of functional outcome scores (e.g., Harris Hip Score, Oxford Hip Score) means the dislocation benefit cannot be contextualized against patient-reported quality-of-life differences between the two constructs.
Original Abstract
BACKGROUND
Total hip arthroplasty (THA) is a common treatment for displaced femoral neck fractures (FNF). Dual mobility (DM) THA has been advocated to reduce dislocation risk in high-risk patients, such as those who have FNF. However, comparative studies remain limited. The purpose of our study was to answer the following questions: (1) What is the dislocation incidence between DM-THA and conventional THA (c-THA) in patients who have FNF? (2) What is the revision incidence between DM-THA and c-THA in patients who have FNF? and (3) What are the risk factors for dislocation in patients who have THA for FNF?
METHODS
A multicenter retrospective cohort study involving 822 patients who underwent THA for displaced FNF at four public hospitals between 2012 and 2020 was conducted. Propensity matching (2:1) balanced age, sex, American Society of Anesthesiologists (ASA) score, surgical approach, and surgeon experience to analyze dislocation and revision incidence between DM-THA and c-THA. Kaplan-Meier survival analysis and multivariable logistic regressions were performed.
RESULTS
Following propensity matching (209 DM-THA versus 418 c-THA), DM-THA demonstrated lower dislocation incidence up to five years (0.5% [95% confidence interval (CI) 0 to 2.5%] versus 4.8% [95% CI 3.0 to 7.2%], P = 0.005). However, there was no difference in revision for instability (DM
THA
0.5% versus c-THA: 2.0%; P = 0.2) or revision for all causes (DM
THA
3.1% versus c-THA: 3.9%; P = 0.3).
CONCLUSION
Use of DM-THA reduces dislocation risk in FNF without increasing overall revision incidence, supporting its use in high-risk patients.