Outcomes of dual mobility versus conventional total hip arthroplasty for patients with femoral neck fractures : a systematic review and meta-analysis including registry data

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Abstract

Background: This study compared the long-term efficacy and safety of dual mobility (DM) prostheses versus conventional total hip arthroplasty (c-THA) in femoral neck fracture (FNF) patients. FNFs have a high rate of post-surgical complications, with no consensus on the optimal prosthetic design. This analysis synthesizes the available evidence to address this gap. Methods: We systematically searched Cochrane, PubMed, and Embase databases for studies comparing DM and c-THA in FNF patients. Outcomes included dislocation, revision, heterotopic ossification, infection, mortality, peri-prosthetic fracture, quality of life, and functional scores. Relative risk (RR) was used for binary endpoints, while mean differences (MD) or standardized mean differences (SMD) were calculated for continuous endpoints. A random-effects model with a 95% confidence interval (CI) was applied. Statistical analyses were conducted using R version 4.4.0. Results: We included three randomized controlled trials and ten cohort studies, amounting to 21,585 patients, of which 4887 received and 16,698 received c-THA. Compared to c-THA, DM showed lower dislocation (RR 0.47; 95% CI: 0.34–0.65; p < 0.001) and revision rates (RR 0.77; 95% CI: 0.67–0.89; p < 0.001) but higher heterotopic ossification (RR 1.98; 95% CI: 1.22–3.20; p < 0.05) and worse functional scores at six to nine months (SMD 1.65; 95% CI: 0.75–2.55; p < 0.001). Meta-regression analysis showed no impact of the posterior approach on dislocation outcomes (p = 0.76). Conclusion: DM reduces dislocation and revision risks but increases heterotopic ossification and shows worse short-term functional outcomes. Larger randomized trials are needed to validate long-term efficacy and safety.