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Meta-Analysis
. 2021 Feb 24;16(1):152.
doi: 10.1186/s13018-021-02316-6.

Outcomes of dual-mobility total hip arthroplasty versus bipolar hemiarthroplasty for patients with femoral neck fractures: a systematic review and meta-analysis

Hsuan-Hsiao Ma  1   2 , Te-Feng Arthur Chou  1   2 , Fu-Yuan Pai  1   2 , Shang-Wen Tsai  3   4 , Cheng-Fong Chen  1   2 , Po-Kuei Wu  1   2 , Wei-Ming Chen  1   2
Affiliations
Meta-Analysis

Outcomes of dual-mobility total hip arthroplasty versus bipolar hemiarthroplasty for patients with femoral neck fractures: a systematic review and meta-analysis

Hsuan-Hsiao Ma et al. J Orthop Surg Res. .

Abstract

Background: Elderly patients with femoral neck fractures are at a higher risk of dislocation after hip arthroplasty procedures. In comparison with total hip arthroplasty (THA), bipolar hemiarthroplasty (HA) and dual-mobility total hip arthroplasty (DM-THA) can be an effective alternative treatment which increases the effective head size and overall stability of the prosthesis. We aim to review the current evidence on the outcome after DM-THA and HA for femoral neck fractures in the elderly.

Methods: We performed a comprehensive review of literatures on PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials and comparative interventional studies. Of the 936 studies identified, 8 met the inclusion criteria (541 DM-THA and 603 HA procedures). Two reviewers independently reviewed and graded each study and recorded relevant data including dislocation rate, implant failure rate, reoperation rate, 1-year mortality rate, Harris hip score (HHS), operation time, and intraoperative blood loss.

Results: DM-THA was associated with a lower dislocation rate (OR 3.599; 95% CI 1.954 to 6.630), a lower reoperation rate (OR 2.056; 95% CI 1.211 to 3.490), an increased operation time (SMD - 0.561; 95% CI - 0.795 to - 0.326) and more intraoperative blood loss (SMD - 0.778; 95% CI - 1.238 to - 0.319), compared with the HA group. Moreover, the multivariate regression analysis revealed that age, female sex, posterolateral surgical approach, and choice of DM-THA or HA were not associated with dislocation or reoperation.

Conclusions: Based on the current evidence, the advantages reported for DM-THA over HA with regard to dislocation and reoperation rate in elderly patients with FNF remain inconclusive. High-quality studies on the high-risk patients with cognitive disorder or dementia are necessary to validate the value of DM-THA.

Keywords: Dislocation; Dual mobility; Elderly; Femoral neck fracture; Hemiarthroplasty; Hip fracture; Reoperation; Total hip arthroplasty.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) flow diagram for the searching and identification of included studies.
Fig. 2
Fig. 2
Forest plot comparing dislocation rate after dual-mobility total hip arthroplasty (DM-THA) versus bipolar hemiarthroplasty (HA)
Fig. 3
Fig. 3
Forest plot comparing implant failure rate after dual-mobility total hip arthroplasty (DM-THA) versus bipolar hemiarthroplasty (HA)
Fig. 4
Fig. 4
Forest plot comparing reoperation rate after dual-mobility total hip arthroplasty (DM-THA) versus bipolar hemiarthroplasty (HA)
Fig. 5
Fig. 5
Forest plot comparing 1-year mortality rate after dual-mobility total hip arthroplasty (DM-THA) versus bipolar hemiarthroplasty (HA)
Fig. 6
Fig. 6
Forest plot comparing Harris hip score after dual-mobility total hip arthroplasty (DM-THA) versus bipolar hemiarthroplasty (HA)
Fig. 7
Fig. 7
Forest plot comparing operation time after dual-mobility total hip arthroplasty (DM-THA) versus bipolar hemiarthroplasty (HA)
Fig. 8
Fig. 8
Forest plot comparing intraoperative blood loss after dual-mobility total hip arthroplasty (DM-THA) versus bipolar hemiarthroplasty (HA)
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