This RCT compared dual mobility total hip replacement (DM-THR) vs. standard THR for hip dislocation risk in adults aged ≥65 with displaced femoral neck fractures across 44 hospitals in Sweden and the UK, with 1-year follow-up.
Dislocation within 1 year occurred in 1.3% (10/779) of the DM-THR group vs. 4.2% (33/787) in the standard THR group — an adjusted HR of 0.27 (95% CI 0.13–0.56; p<0.0001), representing a ~68% relative risk reduction.
Open-label design (neither patients nor surgeons were blinded) introduces potential performance bias. A large proportion of eligible patients were not enrolled — most due to surgeon preference — which may limit generalizability. The trial was conducted in two countries (Sweden and UK), so findings may not extend to all surgical systems or implant brands.
For patients aged ≥65 undergoing THR after a displaced femoral neck fracture, dual mobility cups cut dislocation risk by roughly three-quarters compared to standard cups. DM-THR should be the default choice in this population.
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