Abstract
BackgroundElderly 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.MethodsWe 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.ResultsDM-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.ConclusionsBased 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.
Highlights
Patients with femoral neck fractures are at a higher risk of dislocation after hip arthroplasty procedures
8 studies that compared Dual mobility (DM)-total hip arthroplasty (THA) and HA for patients with femoral neck fractures (FNF) were included for analysis [9,10,11,12,13,14,15,16] (Fig. 1)
The analysis reported a significantly higher reoperation rate after HA than dual-mobility total hip arthroplasty (DM-THA) (OR: 2.056, 95% CI 1.211 to 3.490, I2 = 0, Fig. 4)
Summary
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. Hemiarthroplasty (HA) and total hip arthroplasty (THA) are treatment options for elderly patients with femoral neck fractures (FNF) [1]. In comparison with standard THA, the design of DM-THA increases effective head size which can decrease the rate of dislocation in both primary and revision THA [4]. The development of DMTHA has been a promising prosthesis for the elderly population with FNF since these patients often have increased dislocation rates after standard THA [2, 3, 5].
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have