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
Abstract
1. Introduction
2. Materials and Methods
2.1. Literature Search Strategy
2.2. Inclusion and Exclusion Criteria
2.3. Data Extraction
2.4. Risk of Bias and Study Quality Assessment
2.5. Statistical Analysis
3. Results
3.1. Search Results
3.2. Included Studies Design and Patient Demographics
3.3. Studied Outcomes and Follow-Up
3.4. Operative and Implant Characteristics
3.5. Cognitive and Neuromuscular Status of Patients in the Included Studies
3.6. Outcomes
- (i)
- Operative time
- (ii)
- Estimated blood loss
- (iii)
- Postoperative Harris Hip Score (HHS)
- (iv)
- Dislocation rate
- (v)
- Reoperation rate
- (vi)
- Mortality rate
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
FNF | Femoral Neck Fracture |
HA | Hip Hemiarthroplasty |
THA | Total Hip Arthroplasty |
DM | Dual Mobility |
BH | Bipolar Hip Hemiarthroplasty |
DM-THA | Dual Mobility Total Hip Arthroplasty |
PROMs | Patient Reported Outcome Measures |
RCT | Randomised Controlled Trials |
RoB2 | Cochrane Risk of Bias 2 assessment tool |
NOS | Newcastle-Ottawa Scale |
CI | Confidence Interval |
OR | Odds Ratio |
HHS | Harris Hip Score |
References
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Authors | Year, Country | Study Type | Total Number of Patients (BH/DM) | Time of Surgery | Age at Surgery * (Years) (BH/DM) | Follow up * (Months) (BH/DM) | Sex (BH/DM) (Men–Women) | Studied Outcomes |
---|---|---|---|---|---|---|---|---|
Bensen et al [26]. | 2014, Denmark | RCS | 346 | 2007–2010 | 84.1/75.9 | 25.3/21.7 | 40–131/52–123 | BL, Disl, R & M |
(171/175) | ||||||||
Ochi et al. [27] | 2017, Japan | RCS | 53 | 2009–2015 | 80/75.4 | 28.2/15.8 | 4–16/7–26 | BL, Disl, R & M |
(20/33) | ||||||||
Boukebous et al. [28] | 2018, France | RCS | 199 | 2010–2015 | 83.3/77.8 | 25.8/24.2 | 28–73/28–70 | Disl, R & M |
(101/98) | ||||||||
Kim et al. [29] | 2018, South Korea | RCS | 168 | 2007–2016 | 72.9/73.1 | 22.1/21.7 | 27–57/26–58 | BL, Disl & M, HHS |
(84/84) | ||||||||
Fahad et al. [30] | 2019, Pakistan | RCS | 104 | 2015–2017 | 71.1/69.3 | 20.6/10.9 | 31–46/13–14 | M, HHS |
(77/27) | ||||||||
Iorio et al. [31] | 2019, Italy | RCT | 60 | 2015–2017 | 83/82 | 12/12 | 13–17/12–18 | Disl, R & M |
(30/30) | ||||||||
Ukaj et al. [32] | 2019, Kosovo | RCT | 94 | 2008–2014 | 77.6/78.1 | 36/36 | 32–15/23–24 | BL, Disl, R & M, HHS |
(47/47) | ||||||||
Nonne et al. [33] | 2019, Italy | RCS | 148 | 2013–2017 | 86.1/87.6 | 28.3 | 22–66/15–45 | Disl & R |
(88/60) | ||||||||
Makeen et al. [34] | 2021, Egypt | RCT | 33 | 2018–2020 | 71.1/70.4 | 24 | 10–7/7–9 | BL, HHS Disl |
(17/16) | ||||||||
Bertault-Le Gourrierec et al. [35] | 2022, France | RCS | 265 | 2010–2013 | 85.4/78.5 | 62 | 28–84/42–111 | Disl, R & M |
(112/153) | ||||||||
Cnudde et al. [36] | 2022, Sweeden | RCS | 9033 | 2005–2014 | 83.3/77.9 | ≥36 | 2941–5920/70–102 | Disl, R & M |
(8861/172) | ||||||||
Rotini et al. [37] | 2022, Italy | RCS | 302 | 2018–2019 | 87/84.8 | ≥6 | 31–62/54–155 | Disl & M |
(93/209) | ||||||||
Valcarenghi et al. [38] | 2022, Belgium | RCS | 257 | 2015–2019 | 85/81 | 17.6/18.1 | 26–113/21–97 | Disl, R & M |
(139/118) | ||||||||
Pala et al. [39] | 2024, Italy | RCS | 162 | 2020–2022 | 78/74 | 10.3/14.5 | 20–62/19–61 | BL, HHS Disl &R |
(82/80) | ||||||||
Heshmat et al. [40] | 2024, Egypt | RCT | 40 | 2018–2021 | 72.5/69 | ≥24 | 9–11/5–15 | BL, HHS Disl & M |
(20/20) | ||||||||
Xiao et al. [41] | 2025, China | RCS | 196 | 2017–2021 | 69.1/68.7 | ≥36 | 42–52/43–59 | BL, HHS Disl, R & M |
(94/102) |
Authors | Outcomes | ||||
---|---|---|---|---|---|
Estimated Blood Loss * (mL) | Dislocation Rate ** | Reoperation Rate ** | Mortality Rate *** | HHS ** | |
BH–DM | BH–DM | BH–DM | BH–DM | BH–DM | |
Bensen et al. [26] | 310–424 | 25/171–8/175 | 32/171–16/175 | 50/171–30/175 | N/A |
Ochi et al. [27] | 148–480 | 0/20–0/33 | 2/20–0/33 | 4/20–2/30 | N/A |
Boukebous et al. [28] | N/A | 10/101–3/98 | 9/101–7/98 | 22/101–12/98 | N/A |
Kim et al. [29] | 489–634 | 3/84–2/84 | N/A | 6/84–7/84 | 79.3–83.4 |
Fahad et al. [30] | N/A | N/A | N/A | 4/77–0/27 | 68.8–76.8 |
Iorio et al. [31] | N/A | 5/30–0/30 | 1/30–0/30 | 5/30–4/30 | N/A |
Ukaj et al. [32] | 159–178 | 3/47–0/47 | 4/47–0/47 | 12/47–7/47 | 88.3–92.5 |
Nonne et al. [33] | N/A | 5/88–0/60 | 4/88–1/60 | N/A | 81.7–79.8 |
Makeen et al. [34] | 365–528 | 1/16–1/15 | N/A | N/A | 70.4–77.9 |
Bertault-Le Gourrierec et al. [35] | N/A | 7/112–3/153 | 10/35–9/97 | 102/112–69/152 a | N/A |
Cnudde et al. [36] | N/A | 293/7876–4/149 | N/A | 36.4–27.9% | N/A |
Rotini et al. [37] | N/A | 2/93–4/209 | N/A | 15/93–21/209 b | N/A |
Valcarenghi et al. [38] | N/A | 12/139–2/118 | 26/139–10/118 | 25/139–19/118 | N/A |
Pala et al. [39] | N/A | 0/82–0/80 | 0/82–3/80 | N/A | 81–87.5 |
Heshmat et al. [40] | 700–430 | 2/20–0/– | N/A | 1/20–1/20 c | 88–92.5 |
Xiao et al. [41] | 257–285 | 4/94–2/102 | 1/92–0/102 | 4/94–4/102 | 85–89.5 |
Author | Surgical Approach (BH/DM) | Operative Time * (minutes) (BH/DM) | Fixation Type ** (%) (BH/DM) | Type of Implants (BH/DM) | Other Technical Considerations | Criteria for Allocation to Either BH, DM |
---|---|---|---|---|---|---|
Bensen et al. [26] | PL | 68/74 | US: 94.4/94.6 UC: 98.3 | Stems: Corail/Corail, ANCA-FIT™, Cups: Saturne | PC and SER repair, Limited DM previous experience, MS | Preexisting OA: (DM), SP, Time period: (2007–8: BH, 2009–10:DM) |
Ochi et al. [27] | DAA | 89.4/108.3 | US: 100 UC: 100 | Stems: Profemur TL, AccoladeTMZF, TriLock Cups: Trident, MDM | Fluoroscopy use, additional cups screws in osteoporotic bone, MS | Time period: (2009–13: BH, 2013–15: DM) |
Boukebous et al. [28] | PL | 85/102 | US: 22/ 55 UC: 70 | Stems: Sem3 (CS), Louxor (UC), Cups: Galliléa (CC), Evora (UC) | MS | Time period: (2010–13: BHA, 2013–15: DM) |
Kim et al. [29] | PL | 64.2/77.3 | US: 100 UC: 100 | Stems: Accolade TMZF Cups: Trident PSL MDM | PC and SER repair, fluoroscopy use, SS | Time period: (2007–13: BH 2013–16: DM) |
Fahad et al. [30] | DL, PL | N/A | US: 100 UC: 100 | Stems: porous coated Cups: titanium alloy with HY coating | Cups stabilisation with two pegs and a screw, MS | N/A |
Iorio et al. [31] | DL | 48/59 | US: 100 UC: 100 | Stems: Excia/Pavi Cups: Quattro | N/A | -Randomisation |
Ukaj et al. [32] | PL | 57.8/63.7 | US: 34.4 UC: 100 | Stems: Pavi Cups: Quattro | PC repair, Cups stabilisation with six fins & four spikes, SS | -Randomisation |
Nonne et al. [33] | PL | N/A | US: 85.2 UC: 96.7 | Stems: S-Taper, Korus Cups: Dualis | N/A | N/A |
Makeen et al. [34] | PL | 66/95 | US: N/A UC: 100 | Stems: Exception, CPT/Exception Cups: Serf NOVAE Evolution | -PC and SER repair | -Randomisation |
Bertault-Le Gourrierec et al. [35] | PL | N/A | US: 25 /85 UC: 92 | Stems: N/A/ Cups: Liberty ATF, Novae SERF, others | MS | SP, Patient factors |
Cnudde et al. [36] | DL:65.3%, PL:34.7%/ DL:40.1%, PL:59.9% | N/A | US: 0 UC: N/A | N/A | MS and institutions | Institution dependent |
Rotini et al. [37] | PL | 66.3/78.6 | Both US & CS, (%N/A) Both UC & CC, (%N/A) | Stems: CCA, MS-30, SL/PolarStem, Taperloc, Hype, Apta Fix, Exeter, ABG, Accolade, Apta Cups: PolarCups, Avantage, Novae Stick, Trident, Novae | MS and institutions | SP, Patient factors |
Valcarenghi et al. [38] | PL | N/A | US: most cases, (%N/A) UC: 100 | N/A | PC and SER repair, MS | Preexisting OA: (DM-THA) SP |
Pala et al. [39] | DA:4.9%, PL:3.6%, AL: 91.5%/ DA: 27.5%, PL:12.5%, AL:60% | 85/101 | US: 26.8 UC: 100 | Stems: H-max, CL-trauma /Hype Cups: NOVAE SunFit | MS | Patient factors |
Heshmat et al. [40] | DL | 54.3/81.6 | US: 0 UC: 40 | Stems: N/A Cups: Avantage | MS | -Randomisation |
Xiao et al. [41] | N/A | 76.8/86.4 | N/A | N/A | N/A | N/A |
Author | Cognitive Impairment % (BH/DM) | Neuromuscular Deficit % (BH/DM) |
---|---|---|
Bensen et al. [26] | N/A | N/A |
Ochi et al. [27] | N/A | 10/24.2 |
Boukebous et al. [28] | 50/25 | N/A |
Kim et al. [29] | 0 * | 0 * |
Fahad et al. [30] | N/A | N/A |
Iorio et al. [31] | 100 ** | 0 ** |
Ukaj et al. [32] | 0 | 0 |
Nonne et al. [33] | 100 *** | |
Makeen et al. [34] | N/A | N/A |
Bertault-Le Gourrierec et al. [35] | 27.2 | 5.8 |
Cnudde et al. [36] | 100 *** | |
Rotini et al. [37] | N/A | N/A |
Valcarenghi et al. [38] | 32/40 | N/A |
Pala et al. [39] | 0 * | 0 * |
Heshmat et al. [40] | N/A | N/A |
Xiao et al. [41] | 0 * | 0 * |
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Grammatikopoulos, D.; Pegios, V.F.; Tsotsolis, S.; Kenanidis, E.; Tsiridis, E. 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. J. Clin. Med. 2025, 14, 5076. https://doi.org/10.3390/jcm14145076
Grammatikopoulos D, Pegios VF, Tsotsolis S, Kenanidis E, Tsiridis E. 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. Journal of Clinical Medicine. 2025; 14(14):5076. https://doi.org/10.3390/jcm14145076
Chicago/Turabian StyleGrammatikopoulos, Dimitrios, Vasileios F. Pegios, Stavros Tsotsolis, Eustathios Kenanidis, and Eleftherios Tsiridis. 2025. "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" Journal of Clinical Medicine 14, no. 14: 5076. https://doi.org/10.3390/jcm14145076
APA StyleGrammatikopoulos, D., Pegios, V. F., Tsotsolis, S., Kenanidis, E., & Tsiridis, E. (2025). 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. Journal of Clinical Medicine, 14(14), 5076. https://doi.org/10.3390/jcm14145076