Low revision rate of dual mobility cups after arthroplasty for acute hip fractures: report of 11,857 hip fractures in the Dutch Arthroplasty Register (2007–2019)

Background and purpose — Dislocation is one of the most frequent reasons for cup revision after total hip arthroplasty (THA) for an acute fracture. A dual mobility cup (DMC) might reduce this risk. We determined the cup revision rate after THA for an acute fracture according to type of cup.

Patients and methods — All THAs for an acute fracture registered in the Dutch Arthroplasty Register (LROI) during 2007–2019 were included (n = 11,857). Type of cup was divided into DMC and unipolar cup (UC). Competing risk analyses were performed with cup revision for any reason as endpoint. Multivariable Cox regression analyses with outcome cup revision were performed adjusted for sex, age, ASA class, and surgical approach, stratified for UC THA with femoral head size of 32 mm and 22–28 mm.

Results — A DMC was used in 1,122 (9%) hips. The overall 5-year cup revision rate for any reason after THA for acute fracture was 1.9% (95% CI 1.6–2.2). Cup revision for dislocation within 5 years was performed in 1 of 6 DMC THAs versus 108 of 185 (58%) UC THAs. Univariable Cox regression analyses showed no statistically significant difference in cup revision rate between DMC and UC (HR = 0.8; CI 0.4–1.5). Multivariable Cox regression analyses showed lower risk of cup revision in DMC THA (n = 1,122) compared with UC THA with 22–28 mm femoral head size (n = 2,727) (HR = 0.4; CI 0.2–0.8).

Interpretation — The 5-year cup cumulative incidence of revision after THA for acute fracture was comparable for DMC and UC THA. However, DMC THA had a lower risk of cup revision than UC THA with 22–28 mm femoral head.