Dual Mobility Cup vs. Conventional Total Hip Arthroplasty in Management of Femoral Neck Fractures in Elderly Patients, A Systematic Review and Meta-Analysis

Abstract

Background: Femoral neck fractures are one of the most common traumatic injuries in ageing populations worldwide. They constitute more than 90% of proximal femoral fractures, half of these are intra-capsular. As the ageing population is increasing worldwide the treatment of femoral neck fractures represents a significant burden on health care systems. Objectives: the aim of the study is to compare between conventional total Hip arthroplasty and dual mobility cup Arthroplasty in the incidence of complications with focusing on dislocation rate as a primary outcome in the treatment of fractures neck of femur in elderly patients. Patients and Methods: A meta-analysis study was done on 9 studies that described and compared the 2 different types of total hip arthroplasty for treatment of femoral neck fractures in elderly patients; with the overall number of patients (N= 37852). Results: Regarding 1ry outcome measure which is the dislocation rate The fixed-effect model of the meta-analysis study showed significantly lower dislocation rate in Dual Mobility group (Risk ratio: 0.38, 95% CI 0.28-0.52). Regarding 2ry outcome measures: The fixed-effect model of the meta-analysis study showed significantly lower revision rate in Dual Mobility group (Risk ratio: 0.670, 95% CI 0.60-0.81). The fixed-effect model of the meta-analysis study showed statistically insignificant difference in infection rate between both study groups (Risk ratio: 0.98, 95% CI 0.75-1.29). The fixed-effect model of the meta-analysis study showed statistically insignificant difference in Periprosthetic fracture rate between both study groups (Risk ratio: 0.81, 95% CI 0.58-1.13). The fixed-effect model of the meta-analysis study showed statistically insignificant difference in rate of implant loosening between both study groups (Risk ratio: 0.72, 95% CI 0.48-1.08). The fixed-effect model of the meta-analysis study showed statistically significant higher rate of Heterotopic ossification in Dual mobility group (Risk ratio: 2.6, 95% CI 1.47-4.59). The random-effect model of the meta-analysis study showed statistically significant higher mortality in Dual mobility group (Risk ratio: 1.67 95% CI 0.21-2.15). Conclusion: the findings of this study showed significant difference between using DM-THA and conventional THA for treatment of femoral neck fracture in elderly in dislocation rate and revision rate in favor to DM-THA, heterotropic ossification and mortality rate in favor to conventional THA and showed no significant difference between the 2 groups in other aspects like implant loosening, infection and Periprosthetic fractures.