The role of dual mobility total hip arthroplasty to reduce risk of dislocation in patients with neurological disorders. a systematic review.

Research overview

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BackgroundFemoral neck fractures (FNF) are a significant cause of morbidity and mortality in older adults, often requiring total hip arthroplasty (THA). However, THA is associated with high dislocation rates, particularly in patients with neurological disorders due to factors such as muscle weakness, cognitive impairments, and frequent falls. Dual mobility cups (DMCs) have been proposed as a solution to enhance stability and reduce dislocation rates in this high-risk population. This systematic review aims to evaluate the effectiveness of DMCs in reducing dislocation rates and improving clinical outcomes in patients with FNF and neurological disorders undergoing THA.MethodsFollowing PRISMA guidelines, a systematic search was conducted across PubMed, Cochrane, Embace and Google Scholar up to June 2024. Studies included randomized controlled trials, clinical trials, and retrospective studies focused on DMC use in THA for patients with neurological conditions. Outcomes analyzed included dislocation rates, complications, and patient-reported outcomes such as mobility levels.ResultsData from 12 studies (2017-2023) involving 588 patients were included. The overall mean age of participants was 76.85 years, with 229 males and 376 females. Neurological conditions included Parkinson's disease, dementia, stroke, and others. Dislocation rates were significantly low, with only 2 dislocations reported (0.34%), compared to historically higher rates in standard THA. Complication rates were modest (6%) and primarily involved periprosthetic fractures and infections. Functional outcomes, assessed using tools like the Harris Hip Score (HHS) and WOMAC, demonstrated significant postoperative improvement, with most patients achieving "good" to "excellent" outcomes.ConclusionDual mobility cups in THA significantly reduce dislocation rates and provide favorable functional outcomes in patients with FNF and neurological disorders. DMCs appear to be a safer alternative for high-risk populations, offering improved stability and quality of life. Future studies should focus on long-term outcomes, including implant durability and revision rates.

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