Open Access
Issue
SICOT-J
Volume 7, 2021
Article Number 42
Number of page(s) 8
Section Hip
DOI https://doi.org/10.1051/sicotj/2021041
Published online 17 August 2021

© The Authors, published by EDP Sciences, 2021

Licence Creative CommonsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

THA is widely accepted as the treatment of choice for displaced fracture neck femur in the elderly population [1, 2]. Instability and postoperative dislocation remain among the major concerns and common causes of revision after conventional total hip arthroplasty [3]. The dislocation rate increases from 2–3% at early postoperative follow-up to 4.8% at 10 years and 7% at 25 years postoperatively [4, 5]. Factors influencing postoperative instability include age, activity level, history of previous surgery, soft tissue status, history of trauma, surgical approach, implant position, and diameter of the head and head-neck ratio [68].

Soft tissue and muscle around the hip play a vital role in the stability of the joint. A displaced fracture of the neck of the femur, being an acute traumatic event, results in its damage, making the patient prone to postoperative instability [911]. Increasing the head-neck ratio by increasing the head diameter (above 28 mm) and using an anterior or lateral approach reduces, to some extent, the potential for instability after THR [8, 12, 13].

The dual mobility design of THR implant, first introduced in 1974 by Gilles Bousquet, differs from conventional design in terms of having mobility at two different sites. This reduces the impingement, allows a larger head and greater range of motion [14, 15], and has lower postoperative dislocation rates. [16, 17] The enigma of early wear and intra prosthetic dislocation in the 1st generation implants was solved by 2nd and 3rd generations after incorporating optimal neck design (thin and with mirror polished surface), higher density poly, and larger retention collar [1826]. Therefore, DMTHR has become an attractive option, especially in scenarios with a higher risk of instability like the displaced neck of femur fracture [3].

Literature [2730] has shown the superiority of DMTHR for fracture neck of femur in reducing dislocation rates and requirement of Revision arthroplasty compared to conventional THR. However, studies that have assessed the difference in functional outcome between the two implant designs are lacking. In the Asian subcontinent, lifestyle and religious habits demand squatting, sitting on the floor, sitting cross-legged, and therefore requires higher degrees of range of motion. Thus, the difference in range of motion and ability to go back to pre-injury activity levels is of utmost importance, in between the DMTHR and conventional THR designs, in the Indian subcontinent.

Therefore, we hypothesize that displaced fracture neck of femur in elderly Indian population has better functional outcomes when primarily treated with DMTHR versus conventional THR. The present prospective cohort study aims at testing this hypothesis by comparing the short to mid-term clinical and radiological outcomes of these two groups.

Materials and methods

The present study is a prospective cohort study conducted for one year from August 2018 to July 2019 at a tertiary care center. A total of 115 patients with displaced fracture neck of femur were included in the study. After excluding patients with age < 50 years, polytrauma, neuromuscular disorder, history of previous hip surgery, and the ones with pathological fractures, 103 patients participated in the study (Figure 1).

thumbnail Figure 1

Flow diagram of the study.

All the patients presented to the emergency department. After initial resuscitation, stabilization, and clinical assessment, patients were investigated with plain Anteroposterior and lateral radiographs to confirm the diagnosis. Patients were admitted and operated on for Total Hip Replacement by two different surgeons after a written and informed consent. Fifty-one patients, operated in the first six months, were offered conventional THR, and the remaining fifty-two, operated in the last six months, underwent DMTHR. The demographic data of patients in these two groups are detailed in Table 1.

Table 1

Patient demographics and distribution of implant used.

Surgical technique

Preoperative templating was done in all the patients preoperatively, with the help of true size X-rays with size markers, to predict the implant size, position, and level of neck cut. All patients were operated in the lateral position, with a modified Hardinge approach, and in a similar operative environment. Evolutis Cupules CAPTIV® Dual Mobility Acetabular cups with spike and HACTIV® Sans collarette Avec calerett stems were used for all DMTHR. Whereas Zimmer Continuum® Acetabular System with CLS®/ CPT® 12/14 Femoral System or smith and nephew OXINIUM™ Femoral Heads 12/14 Taper with BASIS™ 12/14 Taper Primary Collared Stems Cobalt Chromium-ASTM F 75 was used for conventional THR. Details of implants and head sizes are mentioned in Table 1. Dual mobility cups were positioned according to the anatomy of the native acetabulum in such a way that there is no superior overhang to allow easy reduction [3]. Cemented or uncemented stem was used depending on bone quality and canal anatomy.

Postoperative rehabilitation

All the patients had a similar rehabilitation protocol. Three doses, one preoperatively and two postoperatively of 1.5 g injectable cefuroxime, were given twelve hours apart. DVT prophylaxis was given in the form of mechanical (DVT stockings, pneumatic compression device) and pharmacological (aspirin or LMWH) methods. All patients were allowed full weight-bearing mobilization from day one and followed the same physiotherapy programme.

Evaluation

All patients were followed up postoperatively at two weeks, six weeks, three months, twelve months, and yearly thereafter with a minimum follow-up of one year. HSS was calculated at three months and twelve months postoperatively. Patient-reported outcome measures (PROM), like the ability to do daily activities, were also assessed. Squatting and sitting cross-legged were allowed to the patients with a head size of more than 36 mm for the conventional THR group and all patients in the DMTHR group. Radiographs were taken at immediate postoperative, at six months, and twelve months; and were evaluated for dislocation, loosening, lysis, and migration.

Statistical analysis

Data recording was done using Microsoft Excel. Descriptive statistics for quantitative data were done using mean ±SD and median and compared with the unpaired T-test. Qualitative data were represented as frequency and percentages; and were compared with the Chi-square test. Data were compared between the two groups – Dual mobility implant and conventional THR implant groups. Range of motion in degrees was analyzed and compared between two groups with the Mann Whitney U test. The Dislocation rates and Modified HHS were analyzed between the two groups by unpaired T-test, Wilcoxon sign Rank test and Mann Whitney U test based on normality testing. The statistics software used was Medcalc.

Results

Study population

With a mean age of 74.48 years, 103 patients with fractured neck of femur were operated on with THR and were available for final follow up at one year. Fifty patients (48.54%) were male, and 49 (47.57%) were operated on the right side. Patients were divided into two groups according to the type of implant used. Fifty-two patients (50.48%) underwent dual mobility THR, and 51 (49.52%) underwent conventional THR. Concerning the preoperative demographic data, operative procedure, and postoperative rehabilitation, both the groups were matched (Table 1).

Clinical outcome

Mean Harris Hip Score (HHS) of the DMTHR group was 76.37 at three months and 87.02 at the end of one year postoperatively, which was significantly better than the conventional THR group 65.65 at three months and 72.96 at one year postoperatively (Table 2). All the patients had a better functional score at one year as compared to three months postoperatively. DMTHR group had better HHS due to better scores in the activity sections (squatting, sitting cross-legged and tying shoelaces) and motion (range of motion). In the conventional THR group, head sizes of 36 mm, 32 mm, and 28 mm were used in 28 (54.9%), 20 (39.2%), and 3 (5.9%) cases, respectively, whereas in the DMTHR group, 28 mm inner head was used in all cases. Eighty percent of DMTHR patients could squat and sit cross-legged versus 55% of the conventional THR patients (with head size more than 36 mm). The mean range of motion for the DMTHR group at 1-year postoperative was 108.65° in flexion, 10° in extension, 28.27° in adduction, 40.77° in abduction, 16.92° in internal rotation, and 40.85° in external rotation; being significantly better than conventional THR group which was 93.53° in flexion, 5° in extension, 23.82° in adduction, 33.33° in abduction, 12.35° in internal rotation, and 37.65° in external rotation. Comparative results are enlisted in Table 2.

Table 2

Table showing the comparison in the functional score between the two groups.

Radiological outcome

Mean cup inclination on the anteroposterior view was 43.3° in the DMTHR group which was not significantly different from 41.9° of the conventional THR group. The radiological follow-up did not show any signs of loosening, radiolucent lines or heterotrophic ossification in any patient.

Complications

All patients were allowed to walk with full weight-bearing and climb stairs by three months postoperatively. None of the patients had any complications intraoperatively. None of the patients had postoperative dislocation or required revision arthroplasty. On the first follow-up, two weeks postoperative, one patient from each group was diagnosed with a superficial infection at the incision site and was resolved completely with debridement and antibiotics. One patient from the conventional THR group had a postoperative urinary tract infection, which was resolved with oral antibiotics. All the patients went back to routine daily activities by 1-year postoperatively.

Discussion

In the present study, the dual mobility group showed significantly better functional outcome of HHS at both the follow-ups than the conventional implant group (p = 0.0001). There is some evidence [3133] in line with this finding. On the other hand, systematic review and metanalysis by Canton et al. [27] and most of the literature on DMTHR [10, 11, 28, 29, 31, 34] have either not been compared or have documented functional outcome equivalent to that with the conventional THR. The score was specifically better in activities sections like sitting cross-legged and squatting and in the motion section. Also, both the groups showed better function at the second follow-up compared with the first of the respective group (p = 0.0001), indicating there were no “late dippers” or delayed complications.

The present study has separately compared the postoperative range of motion of the hip joint in these two groups, which, to our best knowledge, has never been done before and has shown DMTHR to be significantly better than conventional THR. This could be due to the design of a dual mobility cup where a smaller inner head provides most of the effective movement. At the extremes of movement on the inner diameter, the femoral neck abuts the outer femoral head and causes this larger head to articulate with the acetabular component. This, therefore, decreases the incidence of impingement and increases the range of movement [31, 35]. This also supports our finding of better scores in squatting and sitting cross-legged activities that need extremes of the range of movements.

A meta-analysis including 3720 patients by Meek et al. [36] has shown postoperative dislocation after primary THR. It is a dreaded complication with a multifactorial etiology and an incidence of 1% in one month, 1.9% in one year, and a constant increase of 1% every 5 years thereafter. The dislocation rate of THR done for the acute fracture neck of the femur in the early postoperative period is 3.9%, which is 2–4 times more than that of the elective THR [36, 37]. Concerning the surgical approach, the posterior approach is associated with a dislocation rate of 3–8% [37, 38]. Meticulous capsular closure and preservation of pyriformis muscle may reduce the incidence to 1% or less [38], but it remains higher than that with the anterior and lateral approach, which is 0.5–0.6% [13]. The head diameter also influences the postoperative dislocation rate in inverse relation. Increasing the head size from 28 mm to 32 mm and 36 mm reduces the dislocation rates from 1.1% to 0.7% and further to 0.5%, respectively [13].

Some patients are at “high risk” for dislocation after THR associated with epidemiological factors such as old age, impaired cognition, non-compliance to rehabilitation protocol, neuromuscular disorders, and patients with a small acetabular cup that does not allow a large femoral head [39]. There is evidence that bipolar hemiarthroplasty may provide better stability in the fracture neck of the femur [40, 41] and is therefore used by many surgeons in such high-risk patients. The dual mobility design of the implant attempts to lower the postoperative instability by a high femoral head-to-neck ratio by allowing articulation between the metal component and the outer polyethylene bearing, known as the “McKee-Farrar” principle [10, 42], which increases the jump distance required for the femoral head to separate from the acetabular component. The increased jump distance decreases the risk of dislocation when the femoral head or neck impinges on the acetabular component [31, 35]. However, except a few [43, 44], most of the literature evidence [2, 4547] has shown that THR, with Charnley’s principle of low friction arthroplasty, is significantly better than bipolar hemiarthroplasty in terms of long-term functional outcome. Hence, with a combination of these two principles, DMTHR would be an implant to offer the benefits of both [29].

Neri et al. [18], in an original designer retrospective study on Primary DMTHR for 212 cases, showed excellent implant stability and survivorship with no dislocation at a mean follow-up of more than twenty-five years. Zagorov et al. [34] in 2018 compared postoperative dislocation rate with Dual mobility cup with that of conventional THR and Bipolar Hemiarthroplasty for displaced femoral neck fractures and concluded that DMTHR had 0% dislocation rate as compared to 11.1% in conventional THR and 3.1% in bipolar hemiarthroplasty. Similar comparative studies in the literature [10, 11, 2731] have shown the superiority of DMTHR over conventional THR in terms of postoperative stability and requirement of revision arthroplasty and are enlisted in Table 3. In the present study, no difference was found between postoperative dislocation rate, postoperative stability, implant loosening, and rate of revision surgery between the two groups, as none of the patients had any such complication. Factors contributing to this inconsistency could be lateral approach, use of 36 mm head in majority of conventional THR patients, meticulous capsular closure, exclusion of dysplastic patients and patients with neuromuscular disorders.

Table 3

Table showing the comparative studies evaluating the difference in dislocation rates and functional outcome between the DMTHR and conventional THR.

Reluctance in orthopaedic surgeons for dual mobility design was due to previous reports of excessive polyethylene wear (due to dual articulation) [29, 30], aseptic loosening, and intra-prosthetic dissociation with older designs that utilized conventional less dense polyethylene [17, 19], smaller retention collar, and wide rough neck design [18, 4850]. Newer generations of DM articulations have sought to address these issues by incorporating ultra-high molecular weight polyethylene (UHMWPE), improved capture mechanisms with larger retention collar, optimal neck design with mirror polished surface [18, 4850], modular coupling options, non-hemispherical shells, and porous coatings [5153]. This reduces wear particle generation, improves versatility, reduces soft tissue impingement and improves construct stability [5153]. Dual mobility implants increasingly gain recognition in the literature as an effective option to increase postoperative function, survivorship and reducing instability [10, 11, 40, 41, 43, 44, 50, 54]. However, the fact that there are very few long-term studies available has put a limit to its use.

The strengths of this study are matched groups for comparison and separate assessment of the postoperative range of motion. In contrast, the limitations being the small sample size and short duration of follow-up.

Conclusion

The present study concludes that dual mobility implants give better results than conventional single-bearing implants for primary THA in elderly patients of fracture neck of femur in terms of better function and greater range of motion. More long-term multicentric studies are still needed on the same line.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Funding

This research did not receive any specific funding.

Ethical approval

Ethical approval was not required.

Informed consent

This article does not contain any studies involving human subjects.

Authors contribution

Dr Sanjay Agarwala, Dr Ameya Katariya, Dr Mayank Vijayvargiya, Dr Vivek Shetty, Dr Pravin Manohar Swami have contributed equally to the conception, design, drafting, acquisition, analysis and interpretation of data of the study. All authors read and approved the final manuscript

References

  1. Marya SKS, Thukral R, Singh C (2008) Prosthetic replacement in femoral neck fracture in the elderly: Results and review of the literature. Indian J Orthop 42(1), 61–67. [Google Scholar]
  2. Yoo J-I, Cha Y-H, Kim J-T, Park C-H (2019) Clinical outcomes of bipolar hemiarthroplasty versus total hip arthroplasty: assessing the potential impact of cement use and pre-injury activity levels in elderly patients with femoral neck fractures. Hip Pelvis. 31(2), 63. [Google Scholar]
  3. Agarwala S, Shetty V, Taywade S, Vijayvargiya M, Bhingraj M (2020) Dual mobility THR: resolving instability and providing near normal range of movement. J Clin Orthop Trauma 13, 40–45. [Google Scholar]
  4. Berry DJ, von Knoch M, Schleck CD, Harmsen WS (2004) The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 86-A, 9–14. [Google Scholar]
  5. Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. J Bone Joint Surg Am 64, 1295–1306. [Google Scholar]
  6. Goergen TG, Resnick D (1975) Evaluation of acetabular anteversion following total hip arthroplasty: necessity of proper centring. Br J Radiol 48, 259–260. [Google Scholar]
  7. Levy RN, Levy CM, Snyder J, Digiovanni J (1995) Outcome and long-term results following total hip replacement in elderly patients. Clin Orthop Relat Res 316, 25–30. [Google Scholar]
  8. Burroughs BR, Rubash HE, Harris WH (2002) Femoral head sizes larger than 32 mm against highly cross-linked polyethylene. Clin Orthop Relat Res 405, 150–157. [Google Scholar]
  9. Guyen O, Pibarot V, Vas G (2007) Unconstrained tripolar implants for primary total hip arthroplasty in patients at risk for dislocation. J Arthroplasty 22(6), 849–858. [Google Scholar]
  10. Tarasevičius S, Robertsson O, Dobozinskas P, Wingstrand H (2013) A comparison of outcomes and dislocation rates using dual articulation cups and THA for intracapsular femoral neck fractures. HIP Int 23, 22–26. [Google Scholar]
  11. Rowan FE, Salvatore AJ, Lange JK, Westrich GH (2017) Dual-mobility vs fixed-bearing total hip arthroplasty in patients under 55 years of age: a single-institution, matched-cohort analysis. J Arthroplasty 32, 3076–3081. [Google Scholar]
  12. Kelley SS, Lachiewicz PF, Hickman JM, Paterno SM (1998) Relationship of femoral head and acetabular size to the prevalence of dislocation. Clin Orthop Relat Res 355, 163–170. [Google Scholar]
  13. Zijlstra WP, De Hartog B, Van Steenbergen LN, Scheurs BW, Nelissen RGHH (2017) Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty: An analysis of 166,231 procedures in the Dutch Arthroplasty Register (LROI). Acta Orthop 88(4), 395–401. [Google Scholar]
  14. Caton JH, Prudhon JL, Ferreira A, Aslanian T, Verdier R (2014) A comparative and retrospective study of three hundred and twenty primary Charnley type hip replacements with a minimum follow up of ten years to assess whether a dual mobility cup has a decreased dislocation risk. Int Orthop 38, 1125–1129. [Google Scholar]
  15. Lachiewicz PF, Watters TS (2012) The use of dual-mobility components in total hip arthroplasty. J Am Acad Orthop Surg 20, 481–486. [Google Scholar]
  16. Berry DJ, Harmsen WS, Cabanela ME, Morrey BF (2002) Twenty-five-year survivorship of two thousand consecutive primary Charnley total hip replacements. J Bone Joint Surg Am 84(2), 171–177. [Google Scholar]
  17. Boyer B, Philippot R, Geringer J, Farizon F (2011) Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22- year follow-up of 240 hips. Int Orthop 36, 511–518. [Google Scholar]
  18. Neri T, Philippot R, Farizon F, Boyer B (2017) Results of primary total hip replacement with first generation Bousquet dual mobility socket with more than twenty five years follow up. About a series of two hundred and twelve hips. Int Orthop 41, 557–561. [Google Scholar]
  19. Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, Fessy MH, Lecuire F (2008) Survival of cementless dual mobility socket with a mean 17 years follow-up. Rev Chir Orthop Raparatrice Appar Mot 94(8), e23. [Google Scholar]
  20. Vielpeau C, Lebel B, Ardouin L, Burdin G, Lautridou C (2011) The dual mobility socket concept: experience with 668 cases. Int Orthop 35, 225–230. [Google Scholar]
  21. Prudhon J-L, Ferreira A, Verdier R (2013) Dual mobility cup: dislocation rate and survivorship at ten years of follow-up. Int Orthop 37(12), 2345–2350. [Google Scholar]
  22. Leclercq S, Benoit J, De Rosa J, Tallier E, Leteurtre C, Girardin P (2013) Evora® chromium–cobalt dual mobility socket: results at a minimum 10-years’ follow-up. Orthop Traumatol Surg Res 99(8), 923–928. [Google Scholar]
  23. Loving L, Lee RK, Herrera L, Essner AP, Nevelos JE (2013) Wear performance evaluation of a contemporary dual mobility hip bearing using multiple hip simulator testing conditions. J Arthroplast 28(6), 1041–1046. [Google Scholar]
  24. Loving L, Herrera L, Banerjee S, Heffernan C, Nevelos J, Markel DC, Mont MA (2015) Dual mobility bearings withstand loading from steeper cup-inclinations without substantial wear. J Orthop Res 33(3), 398–404. [Google Scholar]
  25. Vigdorchik JM, D’Apuzzo MR, Markel DC, Malkani AL, Raterman S, Sharpe KP, Cornell CN, Westrich GH (2015) Lack of early dislocation following total hip arthroplasty with a new dual mobility acetabular design. Hip Int 25(1), 34–38. [Google Scholar]
  26. Epinette JA (2015) Clinical outcomes, survivorship and adverse events with mobile-bearings versus fixed-bearings in hip arthroplasty-A prospective comparative cohort study of 143 ADM versus 130 trident cups at 2 to 6-year follow-Up. J Arthroplast 30(2), 241–248. [Google Scholar]
  27. Canton G, Moghnie A, Ratti C, Murena L (2018) Dual mobility total hip arthroplasty in the treatment of emoral neck fracture: a systematic review of the literature. Recent Adv Arthroplast 2(1), 32–38. [Google Scholar]
  28. Jobory A, Kärrholm J, Overgaard S, Pedersen AB, Hallan G, Gjertsen J-E, Mäkelä K, Rogmark C (2019) Reduced revision risk for dual-mobility cup in total hip replacement due to hip fracture: a matched-pair analysis of 9,040 cases from the Nordic Arthroplasty Register Association (NARA). J Bone Joint Surg Am 101(14), 1278–1285. [Google Scholar]
  29. Mufarrih SH, Qureshi NQ, Masri B, Noordin S (2020) Outcomes of total hip arthroplasty using dualmobility cups for femoral neck fractures: a systematic review and meta-analysis. Hip Int. 31(1), 12–23. [Google Scholar]
  30. You D, Sepehri A, Kooner S, Krzyzaniak H, Johal H, Duffy P, Schneider P, Powell J (2020) Outcomes of total hip arthroplasty using dual mobility components in patients with a femoral neck fracture. Bone Joint J 102-B(7), 811–821. [Google Scholar]
  31. Darrith B, Courtney PM, Della Valle CJ (2018) Outcomes of dual mobility components in total hip arthroplasty: A systematic review of the literature 2018 The British Editorial Society of Bone & Joint Surgery. Bone Jt J 100B, 11–19. [Google Scholar]
  32. Jauregui J, Pierce T, Elmallah R (2016) Dual mobility cups: an effective prosthesis in revision total hip arthroplasties for preventing dislocations. HIP Int 26, 57–61. [Google Scholar]
  33. Harwin SF, Sultan A, Khlopas A, Sodhi N (2018) Mid-term outcomes of dual mobility acetabular cups for revision total hip arthroplasty. J Arthroplasty 33, 1494–1500. [Google Scholar]
  34. Zagorov M, Mihov K, Dobrilov S, Tabakov A, Gospodinov A, Nenova G (2018) Dual mobility cups reduce dislocation rate in total hip arthroplasty for displaced femoral neck fractures. J IMAB 24(2), 2077–2081. [Google Scholar]
  35. De Martino I, Triantafyllopoulos GK, Sculco PK, Sculco TP (2014) Dual mobility cups in total hip arthroplasty. World J Orthop 5, 180–187. [Google Scholar]
  36. Meek RMD, Allan DB, McPhillips G, Kerr L, Howie CR (2006) Epidemiology of dislocation after total hip arthroplasty. Clin Orthop Relat Res 447, 9–18. [Google Scholar]
  37. Hailer NP, Weiss RJ, Stark A, Kärrholm J (2012) The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. Acta Orthop 83(5), 442–448. [Google Scholar]
  38. Prigent F (2008) Incidence of capsular closure and piriformis preservation on the prevention of dislocation after total hip arthroplasty through the minimal posterior approach: Comparative series of 196 patients. Eur J Orthop Surg Traumatol 18(5), 333–337. [Google Scholar]
  39. Batailler C, Fary C, Verdier R, Aslanian T, Caton J (2017) The evolution of outcomes and indications for the dual-mobility cup: a systematic review. Int Orthop 41, 645–659. [Google Scholar]
  40. Wang F, Zhang H, Zhang Z, Ma C, Feng X (2015) Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-analysis. BMC Musculoskelet Disord 16(1), 1–13. [Google Scholar]
  41. Sierra RJ, Schleck CD, Cabanela ME (2006) Dislocation of bipolar hemiarthroplasty: Rate, contributing factors, and outcome. Clin Orthop Relat Res 442, 230–238. [Google Scholar]
  42. Levin JM, Sultan A, O’Donnell J, Sodhi N, Khlopas A, Piuzzi N (2018) Modern dual-mobility cups in revision total hip arthroplasty: a systematic review and meta-analysis. J Arthroplasty 33, 3793–3800. [Google Scholar]
  43. Narayan KK, George T (2006) Functional outcome of fracture neck of femur treated with total hip replacement versus bipolar arthroplasty in a South Asian population. Arch Orthop Trauma Surg 126, 545–548. [CrossRef] [Google Scholar]
  44. Sonaje JC, Meena PK, Bansiwal RC, Bobade SS (2018) Comparison of functional outcome of bipolar hip arthroplasty and total hip replacement in displaced femoral neck fractures in elderly in a developing country: a 2-year prospective study. Eur J Orthop Surg Traumatol 28(3), 493–498. [CrossRef] [Google Scholar]
  45. Lewis DP, Wæver D, Thorninger R, Donnelly WJ (2019) Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. J Arthroplasty 34(8), 1837–1843. [CrossRef] [Google Scholar]
  46. Ravikumar KJ, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur – 13 Year results of a prospective randomised study. Injury 31(10), 793–797. [CrossRef] [Google Scholar]
  47. Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CML (2010) Treatment of femoral neck fractures in elderly patients over 60 years of age – Which is the ideal modality of primary joint replacement? Patient Safety Surg 4, 16. [CrossRef] [Google Scholar]
  48. Neri T, Philippot R, Klasan A, Putnis S, Leie M, Boyer B (2018) Dual mobility acetabular cups for total hip arthroplasty: advantages and drawbacks. Expert Rev Med Devices 15, 835–845. [CrossRef] [PubMed] [Google Scholar]
  49. Neri T, Boyer B, Geringer J, Di Iorio A, Caton JH, PhiIippot R (2018) Intraprosthetic dislocation of dual mobility total hip arthroplasty: still occurring? Int Orthop 43, 1097–1105. [CrossRef] [PubMed] [Google Scholar]
  50. Neri T, Boyer B, Batailler C, Klasan A, Lustig S, Philippot R (2020) Dual mobility cups for total hip arthroplasty: tips and tricks. SICOTJ. 6, 17. [CrossRef] [EDP Sciences] [Google Scholar]
  51. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE (1994) Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Jt Surg Ser A 76(1), 15–25. [CrossRef] [Google Scholar]
  52. Vigdorchik JM, D’Apuzzo MR, Markel DC, Malkani AL (2015) Lack of early dislocation following total hip arthroplasty with a new dual mobility acetabular design. HIP Int 25(1), 34–38. [CrossRef] [PubMed] [Google Scholar]
  53. McArthur BA, Nam D, Cross MB, Westrich GH, Sculco TP (2013) Dual-mobility acetabular components in total hip arthroplasty. Am J Orthop (Belle Mead NJ) 42(10), 473–478. [Google Scholar]
  54. Mouzopoulos G, Stamatakos M, Arabatzi H, Vasiliadis G (2008) The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options. Int Orthop 32(3), 367–373. [CrossRef] [PubMed] [Google Scholar]

Cite this article as: Agarwala S, Katariya A, Vijayvargiya M, Shetty V & Swami PM (2021) Superior functional outcome with dual mobility THR as compared to conventional THR in fracture neck femur: a prospective cohort study. SICOT-J 7, 42

All Tables

Table 1

Patient demographics and distribution of implant used.

Table 2

Table showing the comparison in the functional score between the two groups.

Table 3

Table showing the comparative studies evaluating the difference in dislocation rates and functional outcome between the DMTHR and conventional THR.

All Figures

thumbnail Figure 1

Flow diagram of the study.

In the text

Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.

Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.

Initial download of the metrics may take a while.