# 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

## TL;DR

This study compares two hip replacement methods for elderly patients with femoral neck fractures and finds that dual-mobility cups offer better recovery and fewer complications, though with longer surgery times.

## Contribution

The study provides a meta-analysis comparing dual-mobility total hip arthroplasty and bipolar hemiarthroplasty for elderly patients with femoral neck fractures.

## Key findings

- Dual-mobility cups showed higher postoperative Harris Hip Scores and lower dislocation risk.
- DM-THA had reduced revision rates and mortality compared to bipolar hemiarthroplasty.
- Operative time and blood loss were higher with DM-THA, showing significant study heterogeneity.

## 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.