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.

Keywords

Double mobility cups dual mobility cups femoral neck fracture femur neck fracture FNF THA total hip arthroplasty

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References

Riggs

Melton

3rd . The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995; 17(Suppl. 5): 505S–511S.

Kannus

Parkkari

Sievänen

, et al. Epidemiology of hip fractures. Bone 1996; 18(Suppl. 1): 57S–63S.

Yoon

Lee

Kim

, et al. Epidemiology of proximal femoral fractures in South Korea. Arch Osteoporos 2013; 8: 157.

Keene

Parker

Pryor

. Mortality and morbidity after hip fractures. BMJ 1993; 307: 1248–1250.

Bentler

Liu

Obrizan

, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 2009; 170: 1290–1299.

White

Griffiths

. Projected incidence of proximal femoral fracture in England: a report from the NHS Hip Fracture Anaesthesia Network (HIPFAN). Injury 2011; 42: 1230–1233.

Burgers

Van Geene

Van den Bekerom

, 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 Orthop 2012; 36: 1549–1560.

Belmont

Jr Garcia

Romano

, et al. Risk factors for complications and in-hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg 2014; 134: 597–604.

Jiang

Yang

Lin

, et al. Does arthroplasty provide better outcomes than internal fixation at mid-and long-term followup? A meta-analysis. Clin Orthop Relat Res 2015; 473: 2672–2679.

10.

Wang

Chen

. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res 2012; 470: 2235–2243.

11.

Iorio

Healy

Lemos

, et al. Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clin Orthop Relat Res 2001; 383: 229–242.

12.

Conroy

Whitehouse

Graves

, et al. Risk factors for revision for early dislocation in total hip arthroplasty. J Arthroplasty 2008; 23: 867–872.

13.

Poignard

Bouhou

Pidet

, et al. High dislocation cumulative risk in THA versus hemiarthroplasty for fractures. Clin Orthop Relat Res 2011; 469: 3148–3153.

14.

Hailer

Weiss

Stark

, 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 Orthop 2012; 83: 442–448.

15.

Ravikumar

Marsh

. Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur—13 year results of a prospective randomised study. Injury 2000; 31: 793–797.

16.

Sanchez-Sotelo

Haidukewych

Boberg

. Hospital cost of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 2006; 88: 290–294.

17.

Johansson

Bachrach-Lindström

Aspenberg

, et al. The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. Int Orthop 2006; 30: 1–6.

18.

Lu-Yao

Keller

Littenberg

, et al. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am 2005; 76: 15–25.

19.

Tarasevicius

Busevicius

Robertsson

, et al. Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture. BMC Musculoskelet Disord 2010; 11: 175.

20.

Adam

Philippe

Ehlinger

, 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 Res 2012; 98: 296–300.

21.

Bensen

Jakobsen

Krarup

. Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures. Int Orthop 2014; 38: 1241–1245.

22.

Philippot

Boyer

Farizon

. Intraprosthetic dislocation: a specific complication of the dual-mobility system. Clin Orthop Relat Res 2013; 471: 965–970.

23.

Neri

Boyer

Geringer

, et al. Intraprosthetic dislocation of dual mobility total hip arthroplasty: still occurring? Int Orthop 2018; 42: 2733.

24.

Laurendon

Philippot

Neri

, et al. Ten-year clinical and radiological outcomes of 100 total hip arthroplasty cases with a modern cementless dual mobility cup. Surgl Technol Int 2018; 32: 331–336.

25.

Moher

Liberati

Tetzlaff

, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097.

26.

Liberati

Altman

Tetzlaff

, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6: e1000100.

27.

Shea

Grimshaw

Wells

, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007; 7: 10.

28.

Vissers

Bussmann

Verhaar

, et al. Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum 2012: 41; 576–588.

29.

Graversen

Jakobsen

Kristensen

, 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 J 2017; 3: 9.

30.

Henawy

Abdel Badie

. Dual mobility total hip arthroplasty in hemiplegic patients. SICOTJ 2017; 3: 40.

31.

Nich

Vandenbussche

Augereau

, 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 Arthroplasty 2016; 31: 1256–1260.

32.

Andersen

Jakobsen

Bensen

, 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 J 2015; 1: 26.

33.

Tarasevicius

Robertsson

Dobozinskas

, et al. A comparison of outcomes and dislocation rates using dual articulation cups and THA for intracapsular femoral neck fractures. Hip Int 2013; 23: 22–26.

34.

Homma

Baba

Ozaki

, 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 Orthop 2017; 41: 491–497.

35.

Kim

Yoo

Kim

, et al. Dual mobility hip arthroplasty provides better outcomes compared to hemiarthroplasty for displaced femoral neck fractures: a retrospective comparative clinical study. Int Orthop 2018; 42: 1241–1246.

36.

Ochi

Baba

Homma

, 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 J 2017; 3: 56.

37.

Boukebous

Boutroux

Zahi

, 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 Res 2018; 104: 369–375.

38.

Rashed

Sevenoaks

Shabaan

, 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. Injury 2018; 49: 667–672.

39.

Assi

Barakat

Caton

, 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 Arthroplasty 2019; 34: 333–337.

40.

Tabori-Jensen

Hansen

Stilling

. 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 Surg 2019; 139: 605–612.

41.

Tabori-Jensen

Hansen

Bøvling

, 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 Aging 2018; 13: 615–621.

42.

Hwang

Kim

, et al. Dislocations after use of dual-mobility cups in cementless primary total hip arthroplasty: prospective multicentre series. Int Orthop 2018; 42: 761–767.

43.

Zagorov

Mihov

Dobrilov

, et al. Dual mobility cups reduce dislocation rate in total hip arthroplasty for displaced femoral neck fractures. J of IMAB 2018; 24: 2077–2081.

44.

Darrith

Courtney

Della-Valle

. Outcomes of dual mobility components in total hip arthroplasty: a systematic review of the literature. Bone Joint J 2018; 100–B: 11–19.

45.

Farizon

de Lavison

Azoulai

, et al. Results with a cementless alumina-coated cup with dual mobility. Int Orthop 1998; 22: 219–224.

46.

Paterno

Lachiewicz

Kelley

. 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 Am 1997; 79: 1202–1210.

47.

Hedlundh

Fredin

. Patient characteristics in dislocations after primary total hip arthroplasty: 60 patients compared with a control group. Acta Orthop Scand 1995; 66: 225–228.

48.

Delaunay

Hamadouche

Girard

, et al. What are the causes for failures of primary hip arthroplasties in France? Clin Orthop Relat Res 2013; 471: 3863–3869.

49.

Johnell

Kanis

. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporosis Int 2004; 15: 897–902.

50.

Guyen

. Hemiarthroplasty or total hip arthroplasty in recent femoral neck fractures? Orthop Traumatol Surg Res 2019; 105: S95–S101.

51.

Adams

Jr Crist

. Hip arthroplasty in femoral neck fractures. In: Borrelli

Anglen

(eds) Arthroplasty for the treatment of fractures in the older patient: indications and current techniques. Switzerland: Springer International Publishing, 2018, pp.165–181.

52.

Liao

Zhao

, et al. A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures. Arch Orthop Trauma Surg 2012; 132: 1021–1029.

53.

Newington

Bannister

Fordyce

. Primary total hip replacement in patients over 80 years of age. J Bone Joint Surg Br 1990; 72: 450–452.

54.

Woolson

Rahimtoola

. Risk factors for dislocation during the first 3 months after primary total hip replacement. J Arthroplasty 1999; 14: 662–668.

55.

Padgett

Warashina

. The unstable total hip replacement. Clin Orthop Relat Res 2004; 420: 72–79.

56.

Patel

Potts

Froimson

. The dislocating hip arthroplasty: prevention and treatment. J Arthroplasty 2007(Suppl. 1); 22: 86–90.

57.

Werner

Brown

. Instability after total hip arthroplasty. World J Orthop 2012; 3: 122–130.

58.

Bourne

Mehin

. The dislocating hip: what to do, what to do. J Arthroplasty 2004; 19: 111–114.

59.

Fackler

Poss

. Dislocation in total hip arthroplasties. Clin Orthop Relat Res 1980; 151: 169–178.

60.

Mertl

Combes

Leiber-Wackenheim

, et al. Recurrence of dislocation following total hip arthroplasty revision using dual mobility cups was rare in 180 hips followed over 7 years. HSS J 2012; 8: 251–256.

61.

D’Angelo

Murena

Zatti

, et al. The unstable total hip replacement. Indian J Orthop 2008; 42: 252–259.

62.

Dobzyniak

Fehring

Odum

. Early failure in total hip arthroplasty. Clin Orthop Relat Res 2006; 447: 76–78.

63.

Masonis

Bourne

. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res 2002; 405: 46–53.

64.

Pellicci

Bostrom

Poss

. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res 1998; 355: 224–228.

65.

McLawhorn

Potter

Cross

, et al. Posterior soft tissue repair after primary THA is durable at mid-term followup: a prospective MRI study. Clin Orthop Relat Res 2015; 473: 3183–3189.

66.

Morrey

. Instability after total hip arthroplasty. Orthop Clin North Am 1992; 23: 237–248.

67.

Soong

Rubash

Macaulay

. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg 2004; 12: 314–321.

68.

Guyen

Chen

Bejui-Hugues

, et al. Unconstrained tripolar hip implants: effect on hip stability. Clin Orthop Relat Res 2007; 455: 202–208.

69.

Howie

Holubowycz

Middleton

. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 2012; 94: 1095–1102.

70.

Garbuz

Masri

Duncan

, 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 Res 2012; 470: 351–356.

71.

Cross

Nam

Mayman

. Ideal Femoral head size in total hip arthroplasty balances stability and volumetric wear. HSS J 2012; 8: 270–274.

72.

Lachiewicz

Heckman

Soileau

, et al. Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years. 2009; 467: 3290–3296.

73.

McKee

Watson-Farrar

. Replacement of arthritic hips by the McKee-Farrar prosthesis. J Bone Joint Surg Br 1966; 48: 245–259.

74.

Simian

Chatellard

Druon

, et al. Dual mobility cup in revision total hip arthroplasty: dislocation rate and survival after 5 years. Orthop Traumatol Surg Res 2015; 101: 577–581.

75.

Bloemheuvel

van Steenbergen

Swierstra

. 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 Orthop 2019; 90: 11–14.

76.

Epinette

Lafuma

Robert

, et al. Cost-effectiveness model comparing dual-mobility to fixed-bearing designs for total hip replacement in France. Orthop Traumatol Surg Res 2016; 102: 143–148.

77.

Brytröm

Espehaug

Furnes

, 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 Scand 2003; 74: 514–524.

78.

Prudhon

Ferreira

Verdier

. Dual mobility cup: dislocation rate and survivorship at ten years of follow-up. Int Orthop 2013; 37: 2345–2350.

79.

Lautridou

Lebel

Burdin

, 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 Mot 2008; 94: 731–739.

80.

Bartels

Gjertsen

Frihagen

, 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 Orthop 2018; 89: 53–58.

81.

Uhler

Schultz

Hill

, et al. Health utility of early hemiarthroplasty vs delayed total hip arthroplasty for displaced femoral neck fracture in elderly patients: a Markov model. J Arthroplasty 32; 1434–1438.

82.

Massin

Orain

Philippot

, et al. Fixation failures of dual mobility cups: a mid-term study of 2601 hip replacements. Clin Orthop Relat Res 2012; 470: 1932–1940.