The edition · Orthopaedics
Dual mobility linked to fewer dislocations but more periprosthetic fractures
In a matched series of uncemented hips, dual-mobility bearings were linked to fewer dislocations but several times the fracture rate, and femoral neck fracture raised the risk of both. Also: physiotherapist-led emergency care, ten-year crosslinked polyethylene wear, and an osteonecrosis score for young femoral neck fractures.
The edition in brief
A single-centre propensity-matched study of 780 uncemented total hip replacements found dual-mobility bearings associated with more periprosthetic femoral fractures than ceramic-on-ceramic (matched OR 3.5) but far fewer dislocations (0.4% vs 4.0%). Femoral neck fracture as the indication raised the risk of both. The Australian RESHAP-ED trial randomised 1,491 adults with uncomplicated musculoskeletal presentations and found physiotherapist-led emergency care cut length of stay by an hour (2.4 vs 3.4 h) with similar adverse events and lower cost. A blinded randomised trial of 96 uncemented knees using radiostereometric analysis found highly crosslinked polyethylene inserts showed no wear progression after five years, while conventional polyethylene wear roughly doubled between five and ten years; component migration did not differ. A retrospective Chinese multicentre study in 1,012 patients aged 18–65 derived an eight-point score for osteonecrosis after cannulated-screw fixation of femoral neck fracture; it outperformed the Garden classification (AUC 0.80 vs 0.70) but needs external validation.
Physiotherapist-led emergency care cut stays by an hour for simple musculoskeletal problems
Consider physiotherapist-led emergency care for uncomplicated musculoskeletal presentations to shorten stays without added harm.
Crosslinked polyethylene in uncemented knees: wear stopped after five years
Highly crosslinked polyethylene is a reasonable choice for uncemented knees, with less late wear than conventional inserts.
An eight-point score for osteonecrosis risk after screw fixation of femoral neck fracture
Consider the eight-point score to counsel younger femoral neck fracture patients on osteonecrosis risk, pending validation.
Check bone and fall risk before you choose the bearing
Assess bone quality and fall risk alongside dislocation risk when choosing a hip bearing.
Dual mobility: fewer dislocations, more periprosthetic fractures
When choosing dual mobility, especially after femoral neck fracture, weigh the higher periprosthetic fracture risk against the lower dislocation risk.
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