Abstract
Background
We hypothesized the risk of prosthetic instability would be similar in patients treated for femoral neck fracture (FNF) comparatively to patients treated for osteoarthritis (OA) using a dual-mobility cup—total hip arthroplasty (DMC-THA).
Methods
One hundred and nine patients (109 hips), with a mean age of 69.6 ± 3 years (65–75 years), underwent DMC-THA using a posterolateral approach for a FNF (study group). Patients were matched for age and sex with 109 OA patients treated by the same procedure (control).
Results
Postoperatively, there were four dislocations of the large articulation in the study group, and none in the control (p = 0.12). Periprosthetic joint infection (PJI) was the most common surgical complication and was more frequent in the study group. Postoperatively, functional results were at least good in > 90% patients in both groups. At the last follow-up, patients in the study group had recovered autonomy and physical activity comparable to those of the preoperative period.
Conclusion
We found no increased risk of dislocation after DMC-THA using a posterolateral approach for FNF as compared to the same procedure for OA. In this study, function and independence were restored postoperatively in the vast majority of patients. DMC-THA appears as a viable therapeutic option in autonomous patients with a displaced FNF.
Keywords: Femoral neck, Fracture, Total hip arthroplasty, Dual-mobility cup, Dislocation, Complications, Matched pair
Introduction
Femoral neck fracture (FNF) is a growing public health issue in developed countries. Its incidence is expected to increase from less than 1.66 million in 1990 to 6.26 million by 2050 worldwide, in parallel with both population aging and prevalence of osteoporosis [1–3]. In this population of fragile patients, FNF regularly leads to loss of independence, and increased morbidity and mortality.
Treatment modalities of displaced FNF include reduction and internal fixation, bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA). In this context, hip arthroplasty is widely accepted as a reference treatment in older people, as it allows early mobilization and immediate full weight bearing [4, 5]. However, the most suitable system of joint replacement is still debated. Traditionally, bipolar HA has been preferred over THA because it has shown a lower rate of dislocation, shorter operative times, and less perioperative blood loss [6–8]. On the other hand, THA results in lower reoperation rates, less postoperative pain, and better functional outcome and mobility compared to HA [8–13], but is associated with higher rates of dislocation [8, 9].
The dual-mobility cup (DMC) was designed for patients at high risk of postoperative hip instability [14–16]. This system is based on two articulating surfaces, including a large articulation between the metallic shell and the mobile polyethylene (PE) insert, and a small one between the insert and the prosthetic head. The use of a DMC system allows for a greater range of motion and a greater jumping distance by limiting the impingement between the head and the cup as compared to conventional THA.
Several studies have reported the effectiveness of DMC-THA in the prevention of prosthetic instability in elective surgery [16–20] and in revision procedures [21]. Regarding DMC-THA for displaced FNF, studies have shown limited rates of dislocation could be expected, from 0 to 4.6% at follow-up ranging from 9 months to 5.6 years [22–25]. However, most of them lack reliable control, making difficult to transpose their conclusion in the clinical practice and to make comparisons between studies. We, therefore, asked whether DMC-THAs for the treatment of patients older than 65 years and younger than 75 years with a displaced FNF would result in similar hip dislocation rates as a group of patients comparable on age and gender treated by DMC-THA for osteoarthritis (OA). We also compared perioperative complications, as well as postoperative function and restoration of autonomy in both groups.
Materials and Methods
Investigational review board approval was not required for this study because it was a retrospective review of patients who were followed up as part of routine clinical care. From January 2014 to December 2020, 317 THAs were done for a FNF at our institution. Inclusion criteria for the present study were: 1) a DMC-THA done using a posterolateral approach for a displaced FNF classified III or IV according to Garden, 2) age between 65 and 75 years, and 3) a minimal 1-year follow-up. Exclusion criteria were as follows: 1) pathologic FNF, 2) a previous history of hip surgery. All patients or their representatives gave informed consent for participation in this study.
All patients were operated via a posterolateral approach with a reconstruction of the posterior capsule and reinsertion of the external rotators with threads at closing. The Novae Sunfit® cup (Serf, Décines, France), a hemispherical cementless dual-mobility cup (porous coating of hydroxyapatite and titanium spray on stainless steel), was employed in all cases. The latter was systematically coupled with an Avenir® femoral stem (Zimmer Biomet, Warsaw, Indiana, USA), either cemented or cementless, with a 12/14 Morse Cone. The inner diameter (the small articulation) was 28 mm. In small-diameter shells (< 45 mm), a 22.2 mm diameter head was used, to maintain a minimal 10-mm PE thickness. The insert and the prosthetic head were articulated on the operating table according to the manufacturer’s recommendations. All patients were given a second generation cephalosporin (Cefacidal) preoperatively as a prophylaxis for infection and a low-molecular-weight heparin for a 30-day period after surgery for thrombosis prophylaxis, in absence of contraindication. Full weight bearing was allowed from the day after surgery. Patients were trained by physiotherapists in our department and then transferred to a care facility.
Postoperatively, patients were followed at regular time intervals (6 weeks, 3 months, 6 months, 12 months…). Clinical evaluation was conducted at the last follow-up by one observer (LR) who did not participate in surgery, using the Merle d’Aubigne hip score [26] and the Devane activity scale [27]. Mobility was evaluated using the Parker mobility score [28]. Postoperative radiographs (anteroposterior pelvis and lateral view of the hip) were analyzed by the same independent observer. Last follow-up radiographs were compared with the immediate postoperative and intermediate radiographs. The presence and progression of radiolucent lines according to the zones described by DeLee and Charnley [29] were evaluated on the pelvic side. Loosening of the cup was defined as cup migration exceeding 3 mm, angular rotation exceeding 3, or a continuous radiolucent line wider than 2 mm. On the femoral side, the progression of radiolucent lines if present were noted, according to the seven zones described by Gruen et al. [30], as well as calcar resorption, and subsidence of the stem. Loosening of the stem was defined using Engh criteria [31].
Perioperative complications were recorded from the medical records and were determined to be of orthopedic (surgical) or medical etiology [32]. In case of dislocation, cup and femoral stem anteversions were systematically evaluated on a computed tomography (CT) scan.
The study population was matched 1:1 for age and sex to patients who underwent elective DMC-THA for primary osteoarthritis (OA) during the same time period at our institution (control group). Specifically, we identified 109 patients (109 hips) who underwent a DMC-THA for primary OA, using the posterolateral approach and the same implant combination. Demographic and clinical data are presented in Table 1.
Table 1.
Demographic, clinical, and perioperative data of patients undergoing DMC-THA for FNF (study group) or for primary OA (control)
| Variable | Study group (FNF) | Control group (OA) | P value |
|---|---|---|---|
| Hips, n (patients) | 109 (109) | 109 (109) | 1 |
| Gender, n (%) | |||
| Male | 33 (30.3) | 33 (30.3) | 1 |
| Female | 76 (69.7) | 76 (69.7) | 1 |
| Mean age ± SD (yrs) | 69.60 ± 2.99 | 69.60 ± 2.99 | 1 |
| BMI, n (%) | |||
| < 30 | 99 (90.83) | 76 (69.72) | 0.0001 |
| 30–40 | 9 (8.25) | 32 (29.35) | 0.001 |
| > 40 | 1 (0.91) | 1 (0.91) | 1 |
| ASA score | 2.1 ± 0.7 | 2 ± 0.5 | 0.28 |
| Specific comorbidities, n (%) | |||
| Tobacco use | 8 ( 7.34) | 28 (25.69) | 0.0003 |
| Diabetes mellitus | 18 (16.51) | 13 (11.93) | 0.3322 |
| Ischemic heart disease | 6 (5.5) | 7 (6.42) | 0.77 |
| Dementia/cognitive disorder | 33 (30.28) | 13 (11.93) | 0.0009 |
| Chronic alcoholism | 17 (15.60) | 5 ( 4.59) | 0.007 |
| Neuromuscular disease | 23 (21.10) | 4 ( 3.67) | < 0.001 |
| Perioperative data | |||
| Cemented stems, n (%) | 41 (37.6) | 11 (10) | < 0.0001 |
| Mean cup size ± SD (mm) | 50.87 ± 2.8 (45–59) | 51.3 ± 3 (45–59) | 0.286 |
| Operative time ± SD (min) | 63 ± 16.7 (40–135) | 55 ± 18 min (30–130) | 0.0013 |
| LOS ± SD (days) | 12.36 ± 14.9 (4- 155) | 7.3 ± 2.7 (3–20) | < 0.0001 |
SD standard deviation, BMI body mass index, ASA American Society of Anesthesiologists, LOS length of stay
Statistical Analysis
Continuous variables were expressed as mean ± standard deviation and range. Categorical variables were expressed as frequency and percentage. Patient characteristics were compared between the two groups using Chi-squared tests (or Fisher’s exact test) for categorical variables and Student t tests for continuous variables. A value of p < 0.05 was considered statistically significant. The survival curves are presented with the Kaplan–Meier method and compared by a log-rank test. Multivariate logistic regression analysis was used to determine the influence of patient-based factors such as age, gender, BMI, comorbidity, on the occurrence of postoperative orthopedic or medical complications.
Results
A total of 109 patients (109 hips) were enrolled (study group), including 33 men (30%) and 76 women (70%), with a mean age of 69.6 ± 3 years (range, 65–75 years). Mean body mass index (BMI) was 23.5 ± 4.3 kg/m2 (range, 13–40 kg/m2). The mean American Society of Anesthesiologists (ASA) score was 2.1 ± 0.7 (range, 1–4), with 22 patients (20%) classified as 3 or greater. Fifty-eight patients (53%) had at least one medical condition increasing the risk of prosthetic instability, such as cognitive impairment, BMI > 30 kg/m2, neuromuscular disease or chronic alcohol consumption. The mean preoperative Devane activity score [27] was 2 (range, 1–4). The mean preoperative Parker mobility score [28] was 7.8 ± 2 (range, 1–9) (Table 1). Before hospital admission, 88 patients (81%) lived at home, whereas 21 patients (19%) lived in retirement home.
The mean delay between hospital admission and surgery was 2.73 ± 2 days (range, 0–12 days), with 49 patients (45%) being operated > 2 days after their admission. A cemented femoral stem was used in 41 hips (37.6%), and a cementless stem was used in 68 hips (62.4%). The inner diameter (the small articulation) was 28 mm in all but two cases. In the latter, a 22.2 mm diameter head was used. The mean length of surgery was 63 ± 16.7 min (range, 40–135 min). Patients were discharged from the hospital after a mean stay of 12.36 ± 14.9 days (range, 4–155 days). Postoperatively, 18% of patients were discharged to home while 82% were transferred to a rehabilitation or care facility.
Four patients in the study group (four hips) (3.6%) were lost at a mean follow-up of 8.5 ± 13.3 months (range, 1.3–28.5 months), whereas one patient (1 hip) (0.9%) in the control group was lost at 24.4 months. Overall, 2.2% patients were lost to follow-up in this series.
Perioperative orthopedic and medical complications in the study group and in the control group are presented in Table 2.
Table 2.
List of intra and postoperative orthopedic and medical complications in the study group and in the control group
| Type of complication | Study group (FNF) | Control group (OA) | P value |
|---|---|---|---|
| Intraoperative complication, n (%) | 6 (5.5) | 6 (5.5) | 0.98 |
| - Fracture of the greater trochanter | 3 (2.75) | 0 (0.0) | 0.7 |
| - Fracture of the calcar | 2 (1.83) | 2 (1.83) | 1 |
| - Cup instability | 1 (0.92) | 4 (3.67) | 0.09 |
| Dislocation, n (%) | 4 (3.7) | 0 (0.0) | 0.1216 |
| Orthopedic complication | 14 (12.84) | 3 (2.75) | 0.037 |
| - Wound haematoma / swelling | 3 (2.75) | 1 (0.92) | 0.042 |
| - PJI | 10 (9.17) | 2 (1.83) | 0.033 |
| - Periprosthetic fracture | 1 (0.92) | 1 (0.92) | 1 |
| Medical complication | 7 (6.4) | 1 (0.92) | 0.038 |
| - UTI/Retention | 1 (0.92) | 0 (0.00) | 1 |
| - DVT/pulmonary embolism | 2 (1.83) | 0 (0.00) | 0.497 |
| - Other medical complications, n (%) | 4 (3.7) | 1 (0.92) | 0.018 |
PJI periprosthetic joint infection, UTI urinary tract infection, DVT deep venous thrombosis
Dislocations
There were four large-articulation dislocations in the study group (3.7%) and none in the control (p = 0.12). Large-articulation dislocations occurred in four female patients, with a mean age of 72 years (range, 67–74 years), after a mean 36.5 ± 11.9 days (range, 19–46 days) after surgery. All underwent initial closed reduction. Computed tomography scan and X-ray revealed a non-displaced trochanteric fracture in one hip, which was treated conservatively. In two other cases, a cup malposition (insufficient anteversion and/or excessive abduction) was identified and led to a cup revision. In the last case, no anomaly was detected on the CT scan. No intraprosthetic dislocation (IPD) was observed in any group. Neither further dislocation nor recurrent dislocation was observed in this series.
Other Orthopedic Complications
The intraoperative complications and their respective treatment were as follows: a greater trochanter fracture that required cerclage wiring (three hips, 2.7%, in the study group versus zero hip in the control) (p = 0.25), a fracture of the calcar that was fixed with a cerclage wire (two cases, 1.8%, in the study group versus two cases, 1.8%, in the control) (p = 1), a poor primary acetabular implant stability that required a cemented cup in a Kerboull cross plate (one hip, 0.9%, in the study group versus four hips, 3.6%, in the control) (p = 0.37).
Beside dislocations, postoperative orthopedic complications included a periprosthetic joint infection (PJI) (ten cases, 9.17%, in the study group vs two cases, 1.83%, in the control) (p = 0.033), a periprosthetic fracture of the femur (one hip, 0.92% in the study group vs one hip, 0.92%, in the control) (p = 1), and wound hematoma or prolonged drainage (three hips, 2.75%, in the study group vs one hip, 0.92%, in the control) (p = 0.43). The cases of PJI were treated either with a «debridement, cleaning, prolonged antibiotics and implant retention» (DAIR) procedure (nine cases in the study group, two cases in the control), or with one-stage implant exchange with adapted antibiotics prolonged at least 6 weeks (one case in the study group, zero case in the control). Periprosthetic fractures of the femur required femoral implant exchange associated with cerclage wiring. Technical parameters, such as operative time and stem cementation were not associated with the risk of medical or orthopedic complications.
Medical Complications and Mortality
There were seven medical complications in the study group (6.4%), including urinary retention (UR) or urinary tract infection (UTI) (one patient, 0.92%), deep venous thrombosis (DVT) or pulmonary embolism (two patients, 1.83%) and others (four patients, 3.7%). Globally, the rate of postoperative medical complications was higher in the FNF group than in the control (p = 0.038) (Table 2). In the study group, 15 patients (15 hips) (13.76%) died at a mean 36.9 ± 24.3 months after surgery (range, 0.85–86 months). In the control group, four patients (four hips) (3.67%) died at a mean 42.3 ± 20.6 months after surgery (range, 8.9–84.2 months). Mortality rates were higher in the study group as compared to the control (p = 0.003). The risk of death was 3.7 times higher in the study group as compared to the control 3.3 years after surgery (Fig. 1). Mortality rates were higher in the study group as compared to the control (p = 0.003). The risk of death was 3.7 times higher in the study group as compared to the control 3.3 years after surgery (Fig. 1).
Fig. 1.
Survival Kaplan–Meier curve in the study group (FNF) and in the control (OA)
Clinical Results
At the last follow-up, the mean Postel Merle d’Aubigne score was 16.7 ± 2 (range, 10–18) in the study group as compared to 17.4 ± 1.2 (range, 13–18) in the control group (p = 0.01). Postoperatively, 90% patients had a functional result rated at least good in the study group, whereas 97% patients had a functional result rated at least good in the control group (p = 0.17). All hips, in both groups, had no pain or rare and mild pain. Preoperatively, 89% patients (n = 97) had a Parker mobility score ≥ 5 and 80 patients (74%) had a Devane activity score ≥ 2 in the study group, as compared to 100% (p < 0.001), and 96% (99 patients) (< 0.0001), respectively, in the control. Taken together, these results indicate that patients in the study group were less autonomous preoperatively comparatively to patients in the control group. Postoperatively, 60 patients (76%) had a Devane activity score ≥ 2 in the study group, as compared to 97 patients (95%) (p < 0.001) in the control. The Devane score consistently improved in 6 patients (8%) in the study group, whereas it improved in 58 patients (59%) in the control (p < 0.001). Conversely, the Devane score decreased in 11 patients (14%) in the study group, whereas it decreased in 3 patients (3%) à in the control group. Taken together, these results indicate that the functional benefit of the DMC-THA was more marked in the OA group than in the FNF group.
Radiographic Results
At the last follow-up evaluation, neither cup nor femoral stem was found to be loose in any group. No radiolucent line could be detected neither on the acetabular nor the femoral side, in any group. No evidence of wear or lysis was detected.
Discussion
Total hip arthroplasty for displaced femoral neck fracture is reportedly associated with improved functional results, less pain, and lower revision rates than bipolar HA [11]. However, THA using a conventional cup for FNF carries a major risk of dislocation, evaluated from 8 to 17% [7–13, 33, 34]. Dual-mobility cup simulates a large-head articulation with an increased jump distance compared to conventional THA [14, 15]. DMC-THA was found to be an efficient mean to prevent dislocation in revision THA or in patients at high risk of dislocation, including in patients with FNF [22–25]. On the basis of these reports, we moved to DMC-THA as the primary treatment of displaced FNF in healthy and relatively active patients, over 65 years, in 2014. In this particular population, we hypothesized a DMC system would result in a drastic limitation of the dislocation rate, comparable to that of a reference population. Therefore, we conducted the current study to (1) evaluate the rate of dislocation in a series of patients with displaced FNF treated with a DMC-THA comparatively to a group of patients with OA treated with a DMC-THA, (2) determine whether this procedure was associated with specific complications in this patient population, (3) report and compare function in both groups.
Our study shows DMC-THA prevented prosthetic instability as effectively in FNF as in OA. In the selected and well-defined population of OA patients, we observed no dislocation at the last follow-up, which is in line with dislocation rates inferior to 1.1% reported in the literature [14, 16–20]. As previously mentioned, neurologic, muscular or cognitive impairment were present more frequently in patients with FNF. Finally, these risk factors had no significant influence on prosthetic instability using a DMC system. Currently, the few cases of prosthetic instability in the study population could only be related to a trochanteric fracture or to a combination of insufficient anteversion and excessive abduction of the cup. Such technical errors may be the result of a learning curve by surgeons with various experiences in elective surgery of the hip, which, again, reflects the reality of a general orthopedics and traumatology department. Therefore, in only one case out of 109 hips (< 1%), we could not find a technical explanation to postoperative dislocation. This compares favorably with low dislocation rates reported in the recent literature regarding the outcome of DMC-THA in FNF (Table 3). Hence, Tarasevicius et al. [22] compared 53 patients treated with a DMC-THA with 42 patients treated with a conventional acetabular cup, all of whom had been operated via a posterolateral approach. After 1 year, no dislocation was observed in the DMC group as compared to 14.3% in the conventional THA group (p < 0.05). Adam et al. [23] reported a dislocation rate of 1.4% in 214 DMC-THAs done via a posterolateral approach in patients with a mean age of 83 years, after 9 months. In a study comparing the outcome of DMC-THA in patients with FNF to those undergoing elective DMC-THA for OA, Homma et al. [35] reported an absence of dislocation in both groups after 13 months. Of note, THAs were done through an anterior approach. In parallel with our findings, these observations suggest surgical approach, whether anterior or posterolateral, has a limited influence on dislocation rates in FNF provided a DMC system is employed. Last, we observed no acute IPD in neither group. This specific complication, reportedly ranging from less than 1–2.2% of DMC-THAs [18, 25], has been related to technical issues, such as using a prosthetic head with skirted neck or with a long neck. None of these options were used in the current series.
Table 3.
Summary of studies reporting results of DMC-THA for femoral neck fracture
| Study | Year of Publication | Number of hips (n) | Age at surgery (yrs) | Surgical Approach (%) | FU (mo) | Overall mortality rate (%) | Rate of Dislocation (%) | IPD (%) |
|---|---|---|---|---|---|---|---|---|
| Tarasevicius et al. [22] | 2010 | 53 | 75 | PL | 12 | 20.7 | 0 | 0 |
| Adam et al. [23] | 2012 | 214 | 83 | PL(80%)/AL(20%) | 9 | 19 | 1.4 | 0 |
| Bensen et al. [24] | 2014 | 175 | 75.2 | PL | 22 | 17.1 | 4.6 | 0 |
| Nich et al. [25] | 2016 | 83 | 86.7 | PL | 24 | 36.5 | 4.4 | 2.2 |
| Homma et al. [35] | 2017 | 40 | 79.5 | Ant | 12 | 2.5 | 0 | 0 |
| Present study (study group) | 2022 | 109 | 69.5 | PL | 40 | 13.7 | 3.66 | 0 |
Yrs years, FU follow-up, mo months, IPD intraprosthetic dislocation, PL posterolateral, Ant. anterior
Regarding the orthopedic complications, eventually leading to reoperation or THA revision, the risk was almost five times greater in the FNF group compared to the OA group (12.84% vs 2.75%). These observations are in line with previous studies, reporting 2.4–7.4% rate of surgical complications in patients with FNF [22–25, 33, 35]. Among these complications, early PJI leading to reoperation were the most frequent in the current study group as compared to the control (9.17% vs 1.83%). This accords well with the 3.8% infection rate after THA reported in a meta-analysis of randomized controlled trials comparing THA and bipolar HA for FNF [8]. Similarly, patients with FNF were more at risk of having a medical complication, such as UTI or DVT, compared to OA patients, as already reported [8, 24]. Higher rates of medical complications, in the range of 6 to 7.5%, had already been reported in FNF patients [25, 35]. Hence, in comparison with their same age OA counterparts, patients with FNF are more prone to develop complications, probably due to their preoperative medical condition. This observation advocates for a proper geriatric perioperative care to balance comorbidities.
At the end of the study, 15 patients (13.7%) in the FNF group had died. As anticipated, this rate was much higher than in the control (3.7%), illustrating the increased risk of death in these patients with associated comorbidities. These rates appear lower than in other studies, reporting rates as high as 36.5% at 2 years postoperatively [25]. This relatively low death rate in our series may be explained by the relatively young age of the patients. We found ASA score > 3 and BMI ≥ 30 kg/m2 were associated with a higher mortality risk. These risk factors have already been reported [23, 36, 37]. In contrast, other epidemiological parameters, such as male sex, older age, or perioperative parameters, such as delay between admission and surgery ≥ 48 h, were not associated with the risk of death. It is likely that the impact of these factors on mortality was less important in the current patients compared to older ones. Therefore, a sustainable hip replacement, like a DMC-THA, appears as a reasonable therapeutic option in this population.
In the current work, good-to-excellent functional results were observed in the vast majority of cases in both groups (90 and 97%, respectively), with neither painful hip nor limitation related to the operated hip. In line with previous studies [23, 25], we report no increase in dependency following DMC-THA for FNF, as shown by the stability of the Parker and Devane scores between the preoperative and the postoperative period. In this unique patient population, DMC-THA could lead to optimal function and restoration of independence.
Limitations
The present study is limited by its retrospective nature. Hence, it is probable some data, such as muscular or cognitive impairment, or nutritional status in FNF patients, have been insufficiently evaluated. In addition, the variable level of experience of surgeons, as encountered in a general orthopedics and traumatology department, might have introduced an imbalance between the groups, as well as preoperative comorbidities, such as psychiatric or cognitive disorders or chronic alcoholism, that were more present in the FNF group. Hence, our study illustrates the difficulty to retrospectively match FNF patients with a control, specifically with regard to risk factors of instability, although age, gender, and technical parameters were similar between groups. However, we believe these points had a minimal influence on final analysis, notably because the dislocation rates were found similar in both groups. Second, although we already reported DMC-THA was associated with limited dislocation risk in patients over 75 years [25], our current findings may not be transposed to patients outside of the 65 to 75 year-old range, which was the focus of the present study. Third, we cannot exclude that the difference in dislocation rates between groups would reach statistical significance in a larger cohort of patients. However, it is probable this would not importantly modify our conclusions because these rates still appear to be very low.
Conclusion
In this study, we found no increased risk of dislocation after DMC-THA using a posterolateral approach for FNF as compared to the same procedure for OA, in patients aged between 65 and 75 years. In this patient population at high risk of prosthetic instability, the DMC system was not only effective in the prevention of postoperative dislocation, but was also an efficient treatment to restore function and maintain patient’s independence after injury. Although further studies are needed to evaluate the outcome of this procedure in other populations of patients with FNF and also to analyze its cost-effectiveness, we found DMC-THA was a viable option in autonomous patients with a displaced FNF.
Author Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by LR, KB, and FF. The first draft of the manuscript was written by CN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Funding
The authors did not receive support from any organization for the submitted work.
Availability of Data and Materials
Data are available on request.
Declarations
Conflict of Interest
Christophe Nich is consultant to Zimmer Biomet and Groupe Lepine. The other authors have no financial or proprietary interests in any material discussed in this article.
Ethical Approval
The current work is original and has not been submitted to another journal for publication. The study was conducted according to the guidelines of the 1964 Declaration of Helsinki, and due to the non-interventional nature of the study, no approval from an ethics committee was necessary at the time of the beginning of the study. The study was reported to the “Direction de la Recherche Clinique” (DRC) of the University Hospital of Nantes, France. The requisite processes were undertaken with the “Commission Nationale de l’Informatique et des Libertés” (CNIL).
Consent to Participate
Informed consent was obtained from all individual participants included in the study.
Consent to Publish
Informed consent was obtained from all individual participants included in the study.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Lucie Regennass, Email: lucie.regennass@yahoo.fr.
Kevin Brulefert, Email: dr.brulefert.kevin@gmail.com.
Fanny Feuillet, Email: fanny.feuillet@chu-nantes.fr.
Christophe Nich, Email: pr.christophe.nich@gmail.com.
References
- 1.Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA, IOF CSA Working Group on Fracture Epidemiology Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporosis International. 2011;22(5):1277–1288. doi: 10.1007/s00198-011-1601-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996;18(1 Suppl):57–63. doi: 10.1016/8756-3282(95)00381-9. [DOI] [PubMed] [Google Scholar]
- 3.Sterling RS. Gender and race/ethnicity differences in hip fracture incidence, morbidity, mortality, and function. Clinical Orthopaedics and Related Research. 2011;469(7):1913–1918. doi: 10.1007/s11999-010-1736-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P, 3rd, Obremskey W, Koval KJ, Nork S, Sprague S, Schemitsch EH, Guyatt GH. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. The Journal of Bone and Joint Surgery American Volume. 2003;85(9):1673–1681. doi: 10.2106/00004623-200309000-00004. [DOI] [PubMed] [Google Scholar]
- 5.Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: A meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthopaedica. 2006;77(3):359–367. doi: 10.1080/17453670610046262. [DOI] [PubMed] [Google Scholar]
- 6.Sierra RJ, Schleck CD, Cabanela ME. Dislocation of bipolar hemiarthroplasty: Rate, contributing factors, and outcome. Clinical Orthopaedics and Related Research. 2006;442:230–238. doi: 10.1097/01.blo.0000183741.96610.c3. [DOI] [PubMed] [Google Scholar]
- 7.Parker MJ, Gurusamy K. Cochrane database of systematic reviews. Chichester: John Wiley & Sons Ltd; 2006. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. [DOI] [PubMed] [Google Scholar]
- 8.Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: Meta-analysis of randomized trials. Clinical Orthopaedics and Related Research. 2012;470(8):2235–2243. doi: 10.1007/s11999-012-2293-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, Tidermark J. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. The Journal of Bone and Joint Surgery. 2011;93(5):445–450. doi: 10.2106/JBJS.J.00474. [DOI] [PubMed] [Google Scholar]
- 10.Macaulay W, Nellans KW, Garvin KL, Iorio R, Healy WL, Rosenwasser MP. Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: Winner of the Dorr Award. The Journal of Arthroplasty. 2008;23(6 Suppl 1):2–8. doi: 10.1016/j.arth.2008.05.013. [DOI] [PubMed] [Google Scholar]
- 11.Hopley C, Stengel D, Ekkernkamp A, Wich M. Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: Systematic review. British Medical Journal. 2010;340:c2332. doi: 10.1136/bmj.c2332. [DOI] [PubMed] [Google Scholar]
- 12.Baker RP, Squires B, Gargan MF, Bannister GC. Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. The Journal of Bone and Joint Surgery American Volume. 2006;88(12):2583–2589. doi: 10.2106/JBJS.E.01373. [DOI] [PubMed] [Google Scholar]
- 13.Wang F, Zhang H, Zhang Z, Ma C, Feng X. Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-analysis. BMC Musculoskeletal Disorders. 2015;16:229. doi: 10.1186/s12891-015-0696-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Farizon F, de Lavison R, Azoulai JJ, Bousquet G. Results with a cementless alumina-coated cup with dual mobility. A twelve-year follow-up study. International Orthopaedics. 1998;22(4):219–224. doi: 10.1007/s002640050246. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Stulberg SD. Dual mobility for chronic hip instability: A solution option. Orthopedics. 2010;33(9):637. doi: 10.3928/01477447-20100722-51. [DOI] [PubMed] [Google Scholar]
- 16.Guyen O, Pibarot V, Vaz G, Chevillotte C, Carret JP, Bejui-Hugues J. Unconstrained tripolar implants for primary total hip arthroplasty in patients at risk for dislocation. The Journal of Arthroplasty. 2007;22(6):849–858. doi: 10.1016/j.arth.2006.11.014. [DOI] [PubMed] [Google Scholar]
- 17.Philippot R, Camilleri JP, Boyer B, Adam P, Farizon F. The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: Analysis of 384 cases at a mean follow-up of 15 years. International Orthopaedics. 2009;33(4):927–932. doi: 10.1007/s00264-008-0589-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Hamadouche M, Arnould H, Bouxin B. Is a cementless dual mobility socket in primary THA a reasonable option? Clinical Orthopaedics and Related Research. 2012;470(11):3048–3053. doi: 10.1007/s11999-012-2395-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Combes A, Migaud H, Girard J, Duhamel A, Fessy MH. Low rate of dislocation of dual-mobility cups in primary total hip arthroplasty. Clinical Orthopaedics and Related Research. 2013;471(12):3891–3900. doi: 10.1007/s11999-013-2929-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Boyer B, Philippot R, Geringer J, Farizon F. Primary total hip arthroplasty with dual mobility socket to prevent dislocation: A 22-year follow-up of 240 hips. International Orthopaedics. 2012;36(3):511–518. doi: 10.1007/s00264-011-1289-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Hamadouche M, Biau DJ, Huten D, Musset T, Gaucher F. The use of a cemented dual mobility socket to treat recurrent dislocation. Clinical Orthopaedics and Related Research. 2010;468(12):3248–3254. doi: 10.1007/s11999-010-1404-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Tarasevicius S, Busevicius M, Robertsson O, Wingstrand H. Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture. BMC Musculoskeletal Disorders. 2010;11:175. doi: 10.1186/1471-2474-11-175. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Mole D, Fessy MH, French Society of Orthopaedic Surgery and Traumatology (SoFCOT) Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Orthopaedics and Traumatology: Surgery and Research. 2012;98(3):296–300. doi: 10.1016/j.otsr.2012.01.005. [DOI] [PubMed] [Google Scholar]
- 24.Bensen AS, Jakobsen T, Krarup N. Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures. International Orthopaedics. 2014;38(6):1241–1245. doi: 10.1007/s00264-013-2276-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Nich C, Vandenbussche E, Augereau B, Sadaka J. Do dual-mobility cups reduce the risk of dislocation in total hip arthroplasty for fractured neck of femur in patients aged older than 75 years? The Journal of Arthroplasty. 2016;31(6):1256–1260. doi: 10.1016/j.arth.2015.11.041. [DOI] [PubMed] [Google Scholar]
- 26.Merle dR. Cotation chiffrée de la fonction de la hanche. Revue de Chirurgie Orthopedique et Reparatrice de l’Appareil Locomoteur. 1990;76(6):371–374. [PubMed] [Google Scholar]
- 27.Devane PA, Horne JG, Martin K, Coldham G, Krause B. Three-dimensional polyethylene wear of a press-fit titanium prosthesis. Factors influencing generation of polyethylene debris. The Journal of Arthroplasty. 1997;12(3):256–266. doi: 10.1016/s0883-5403(97)90021-8. [DOI] [PubMed] [Google Scholar]
- 28.Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. The Journal of Bone and Joint Surgery Bristish Volume. 1993;75(5):797–798. doi: 10.1302/0301-620X.75B5.8376443. [DOI] [PubMed] [Google Scholar]
- 29.DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clinical Orthopaedics and Related Research. 1976;121:20–32. [PubMed] [Google Scholar]
- 30.Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: A radiographic analysis of loosening. Clinical Orthopaedics and Related Research. 1979;141:17–27. [PubMed] [Google Scholar]
- 31.Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. The Journal of Bone and Joint Surgery Bristish Volume. 1987;69(1):45–55. doi: 10.1302/0301-620X.69B1.3818732. [DOI] [PubMed] [Google Scholar]
- 32.Kurtz SM, Lau EC, Ong KL, Adler EM, Kolisek FR, Manley MT. Hospital, patient, and clinical factors influence 30- and 90-day readmission after primary total hip arthroplasty. The Journal of Arthroplasty. 2016;31(10):2130–2138. doi: 10.1016/j.arth.2016.03.041. [DOI] [PubMed] [Google Scholar]
- 33.Liao L, Zhao Jm SuW, Xf D, Lj C, Sx L. A meta-analysis of total hip arthroplasty and hemiarthroplasty outcomes for displaced femoral neck fractures. Archives of Orthopaedic and Trauma Surgery. 2012;132(7):1021–1029. doi: 10.1007/s00402-012-1485-8. [DOI] [PubMed] [Google Scholar]
- 34.Burgers PT, Van Geene AR, Van den Bekerom MP, Van Lieshout EM, Blom B, Aleem IS, Bhandari M, Poolman RW. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-analysis and systematic review of randomized trials. International Orthopaedics. 2012;36(8):1549–1560. doi: 10.1007/s00264-012-1569-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Homma Y, Baba T, Ozaki Y, Watari T, Kobayashi H, Ochi H, Matsumoto M, Kaneko K. In total hip arthroplasty via the direct anterior approach, a dual-mobility cup prevents dislocation as effectively in hip fracture as in osteoarthritis. International Orthopaedics. 2017;41(3):491–497. doi: 10.1007/s00264-016-3332-y. [DOI] [PubMed] [Google Scholar]
- 36.Maxwell MJ, Moran CG, Moppett IK. Development and validation of a preoperative scoring system to predict 30 day mortality in patients undergoing hip fracture surgery. Bristish Journal of Anaesthesia. 2008;101(4):511–517. doi: 10.1093/bja/aen236. [DOI] [PubMed] [Google Scholar]
- 37.Chia PH, Gualano L, Seevanayagam S, Weinberg L. Outcomes following fractured neck of femur in an Australian metropolitan teaching hospital. Bone and Joint Research. 2013;2(8):162–168. doi: 10.1302/2046-3758.28.2000177. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data are available on request.