الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
 |  | from | 39 |  |  |
| | | from | 39 | | |
Abstract
The aim of this work is to provide cumulative data about the efficacy and safety of dual mobility total hip arthroplasty (DM-THA) vs. conventional total hip arthroplasty (THA) for treatment of femoral neck fractures in elderly patients.
We found that; the included studies published between 2010 and 2021.
The total number of patients in all the included studies was 37852 patients; 7860 in DM-THA group and 29992 in THA group, with 14000 male patients and 23852 female patients.
The average follow up time was (1.86 years); with longest follow up time of 3.7 years in Hoskins et al.,2021 study[71]; and shortest follow up time of 1 year in R.A.Rashed et al.,2020, R.A.M.Rashed et al.,2020, Tarasevicius et al., 2010 and Tarasevicius et al., 2013[72][1][48][73]
The average age of all patients was (73.2 years); with youngest mean age of 67.2 years in R.A.Rashed et al., 2020 study[1]; and oldest mean age of 80 years in Ochi et al., 2017[76] study.
Meta-analysis study was done on 9 studies which described and compared the 2 different techniques for femoral neck fractures; with overall number of patients (N= 37852).
Eleven studies done between 2012 and 2021 discuss result of DM-THA in treating fracture neck of the femur in elderly patients but not included in the systematic review because of lacking of control group (THA group).
Adam et al., in a prospective, systematic, multicenter study[50] of 214 hips reported that the use of dual mobility cups in treatment displaced femoral neck fractures through posterior approach had a low dislocation rate of 1.4%.
Nich et al., in a retrospective study[77] of 82 hips aged more than 75 years reported that the use of dual mobility cups in treatment displaced femoral neck fractures through posterolateral approach had a low dislocation rate of 4.4%.
Graverson et al., in his study[78] of 20 patients with dementia and displaced femoral neck fracture treated with DM-THA through posterior approach reported NO dislocation over a period of 1.1 years.
Hyo Hwang et al., in prospective multicenter study[79] [80]of 142 patients of femoral neck fracture reported that the use of dual mobility cups in treatment displaced femoral neck fractures had a low dislocation rate of 2.81%.
Tabori-Jensen et al., in a retrospective cohort study[81] of 966 patients with femoral neck fracture treated with DM-THA through posterolateral approach reported acceptable dislocation rate of 4.7 % and a low revision rate of 2.7 % over an average follow up period of 5.4 years.
Assi et al., in a retrospective study[82] of 125 patients with femoral neck fracture treated with DM-THA concluded that DMC implant showed excellent clinical and functional results and low dislocation rate of 1.6 %.
Canton et al., in a retrospective cohort study[83] [84]of 31 patients with femoral neck fracture treated with DM-THA through direct lateral approach reported good clinical results and no dislocation or intra-prosthetic dislocation over an average follow up period of 5.67 years.
Erasmus et al., in a retrospective study[85] of 41 patients with femoral neck fracture treated with DM-THA through posterior approach reported good clinical results and no dislocation or intra-prosthetic dislocation over an average follow up period of 1 year.
Jinnai et al., in a retrospective study[86] of 106 patients with femoral neck fracture treated with DM-THA through anterior approach reported quick recovery of walking ability with no dislocation and low one year mortality rate of 5.7% over an average follow up period of 1 year.
Zhang et al., in a retrospective study[87] of 112 patients with femoral neck fracture treated with DM-THA through anterior approach reported favorable functional outcome and no dislocation and low rate of revision (1.7%) over an average follow up period of 5 year.
Ryu et al., in a retrospective study[88] of 162 patients with femoral neck fracture (35 patients with neuromuscular disorders) treated with DM-THA reported that there was no difference in the incidence of dislocation between patients with or without neuromuscular disease treated by THA using a dual mobility cup. All clinical scores and re-operation rates were also comparable between the two groups.
In our systematic review and metaanalysis, We found 8 studies [69][71][70][76][1][48][73][75] reporting 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:
We found 6 studies [75][48][69][71][70][76] reporting revision rate. 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).
We found 4 studies [75][48][69][1] reporting postoperative wound infection. 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).
We found 4 studies [75][48][69][75] reporting Periprosthetic fracture rate. 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).
We found 4 studies [75][48][69][48] reporting rate of implant loosening. 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).
We found 4 studies [69][1][72][75] reporting rate of Heterotopic ossification. 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).
We cannot provide an explanation for the increased incidence of HO in the DMC group. A possible explanation could be the muscular trauma that may have happened as a result of the fall that led to the fracture. However this still does not explain the lower incidence of HO in the conventional THR group.
We found 7 studies [69][70][76][1][48][73][75] reporting Mortality rate. 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).