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Review
. 2025 Jul 17;14(14):5076.
doi: 10.3390/jcm14145076.

Are There Benefits of Total Hip Arthroplasty with Dual-Mobility Cups Compared to Bipolar Hemiarthroplasty for Femoral Neck Fractures in the Geriatric Population? A Systematic Review and Meta-Analysis of Comparative Studies

Dimitrios Grammatikopoulos  1 , Vasileios F Pegios  1 , Stavros Tsotsolis  1 , Eustathios Kenanidis  1 , Eleftherios Tsiridis  1
Affiliations
Review

Are There Benefits of Total Hip Arthroplasty with Dual-Mobility Cups Compared to Bipolar Hemiarthroplasty for Femoral Neck Fractures in the Geriatric Population? A Systematic Review and Meta-Analysis of Comparative Studies

Dimitrios Grammatikopoulos et al. J Clin Med. .

Abstract

Background/Objectives: The optimal treatment for femoral neck fractures (FNFs) in the elderly remains unclear. Internal fixation, bipolar hip hemiarthroplasty (BH), standard total hip arthroplasty (THA), or dual mobility (DM-THA) cups have been employed, each presenting various advantages and disadvantages. This systematic review and meta-analysis evaluated comparative studies of BH and DM-THA in FNFs among the elderly, aiming to ascertain differences in outcomes, including functional recovery, patient-reported outcome measures, implant survival, complications, and mortality rates. Methods: This meta-analysis followed PRISMA 2020 guidelines with a pre-registered PROSPERO protocol (CRD420251065762). A comprehensive search of electronic databases and grey literature included only comparative studies of BH and DM-THA in patients over 65 years with FNFs. Results: Sixteen studies were eligible, comprising four randomised controlled trials and twelve retrospective comparative studies involving 11,460 patients (10,036 BH; 1424 DM-THA). Patients with DM-THA exhibited a higher postoperative Harris Hip Score (4.55, p < 0.0001), alongside a lower dislocation risk ([OR] 2.77, p < 0.0001), a reduced revision rate ([OR] 2.36, p < 0.0001), and decreased mortality ([OR] 1.94, p < 0.0001). The operative time was somewhat longer in the DM-THA group, by 12.71 min, and blood loss was greater by 121 mL, indicating significant heterogeneity across the studies. Conclusions: DM-THA for FNFs in elderly patients results in improved functional recovery and lower dislocation, reoperation, and mortality risk. However, longer operative times and increased blood loss remain significant considerations. Further, well-designed comparative studies are required to evaluate overall cost-effectiveness and define the optimal age threshold, beyond which the limitations of DM-THA may outweigh its benefits.

Keywords: complications; femoral neck fractures; frail elderly; hemiarthroplasty; meta-analysis; reoperation; survival; total hip arthroplasty.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart. DM: Dual Mobility Total Hip Arthroplasty, BH: Bipolar Hemiarthroplasty, THA: Total Hip Arthroplasty.
Figure 2
Figure 2
Forest plot for comparison of Operative Time [26,27,28,29,31,32,34,37,39,40,41].
Figure 3
Figure 3
Forest plot for comparison of Estimated Blood Loss [26,27,29,32,34,40,41].
Figure 4
Figure 4
Forest plot for comparison of Postoperative Harris Hip Score [29,30,32,33,34,39,40,41].
Figure 5
Figure 5
Forest plot for comparison of Dislocation Rate [26,27,28,29,31,32,33,34,35,36,37,38,39,40,41].
Figure 6
Figure 6
Forest plot for comparison of Reoperation Rate [26,27,28,31,32,33,35,38,39,41].
Figure 7
Figure 7
Forest plot for comparison of Mortality Rate [26,27,28,29,30,31,32,33,34,36,38,39,41].
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