Post-operative complications following total hip arthroplasty for trauma: A multicentre cohort study comparing dual mobility with conventional acetabular bearings

Lee Hoggett; Dinesh Alexander; Anthony Helm; NWORC Collaborative

doi:10.1016/j.jor.2023.04.013

Post-operative complications following total hip arthroplasty for trauma: A multicentre cohort study comparing dual mobility with conventional acetabular bearings

J Orthop. 2023 Apr 22:40:34-37. doi: 10.1016/j.jor.2023.04.013. eCollection 2023 Jun.

Authors

Lee Hoggett¹, Dinesh Alexander¹, Anthony Helm²; NWORC Collaborative

Collaborators

NWORC Collaborative:
Jennifer Barclay³, Sandeep Damaraju³, Hannah Wilkinson⁴, Mazen Soufi⁵, Clare Cullen⁵, Kareem Elsorafy⁵, Syed Mustafa⁵, Zoubaida Yahia⁵, Sadaf Naderi⁵, Mike Greenhalgh⁶, David Knowles⁶, Martin Sharrock⁷, Deepak Herlekar⁷, Thomas Collins⁸, James Mace⁸, Sophie Rogers⁸, Samir Talha⁹, David Johnson⁹, Albert Chikate¹⁰, Krishan Kulkarni¹⁰, Richard Unsworth¹¹, Hiren Divecha¹¹, Thomas Naylor¹²

Affiliations

¹ Health Education North West, Trauma and Orthopaedic Surgery, UK.
² Lancashire Teaching Hospitals NHS Foundation Trust, Trauma and Orthopaedic Surgery, UK.
³ Lancashire Teaching Hospitals, UK.
⁴ Blackpool Teaching Hospitals, UK.
⁵ East Lancashire Teaching Hospitals NHS Foundation Trust, UK.
⁶ Morcambe Bay Hospitals (Barrow), UK.
⁷ Morcambe Bay Hospitals (Lancaster), UK.
⁸ Bolton NHS Foundation Trust, UK.
⁹ Stockport NHS Foundation Trust, UK.
¹⁰ Northern Care Alliance NHS Foundation Trust (Salford), UK.
¹¹ Wrightington Wigan and Leigh NHS Foundation Trust, UK.
¹² Manchester University NHS Foundation Trust (North Manchester General), UK.

PMID: 37159824
PMCID: PMC10163605 (available on 2024-06-01)
DOI: 10.1016/j.jor.2023.04.013

Abstract

Aims: Dislocation of a total hip replacement is a serious complication after total hip arthroplasty (THA). Dislocation rates are higher when surgery is performed following trauma. Our study compares post-operative dislocation rates between conventional acetabular bearing (CAB) and dual mobility acetabular bearing (DMB) THA performed for neck of femur fracture alongside post-operative periprosthetic fracture, revision and mortality.

Methods: A retrospective multicentre cohort study at 9 hospital trusts in the United Kingdom of all THA performed for neck of femur fracture between March 2018 and February 2019.

Results: A total of 295 operations were performed. 64% (189) were CAB and 36% (106) were DMB. Average age was 75 years (38-98). 223 Female: 72 Male. The follow-up period was an average of 42 months (36-48). Overall revision rate was 1.6%,⁸ peri-prosthetic fracture rate was 6 (2%) and overall mortality was 9.8% (29) with no significant difference between cohorts for any outcome. The posterior approach (PA) was favoured 82% (242) vs the lateral approach (LA) 18% (53) with the PA used more often in patients undergoing DMB 96% (102) vs CAB 74% (140) p = 0.001. Patients approached posteriorly at the time of their index procedure were significantly less likely to sustain a simple dislocation following a DMB 0 (0%) vs. CAB 8 (5.7%) p = 0.015.

Conclusion: Our study demonstrates that the risk of dislocation following THA for trauma is more than four times higher than when conventional bearings are used compared to dual mobility acetabular components. This effect is most pronounced when the PA is utilised for the index procedure. The use of these bearings does not impact mortality, peri-prosthetic fracture or revision rate. We would encourage the use of dual mobility acetabular bearings in patients undergoing THA for fracture via a PA.