Dual mobility hip implant cuts dislocation risk after fracture

Clinical takeaway: For adults aged 65 years or older undergoing total hip replacement for a displaced femoral neck fracture, consider a dual mobility acetabular cup to reduce postoperative dislocation risk, particularly in patients at elevated risk for instability.

Dislocation is the most common early surgical complication after total hip replacement (THR) for displaced femoral neck fractures. Preventing these events can reduce patient morbidity, repeat procedures, and health-care utilization.

In the international, registry-based DUALITY trial, investigators randomized 1,600 adults aged 65 years or older at 44 hospitals in Sweden and the UK to receive either a dual mobility or standard acetabular cup during THR for a displaced femoral neck fracture. Nearly 98% of participants were included in the primary analysis after 1 year of follow-up.

Hip dislocation occurred in 1.3% of patients who received a dual mobility implant compared with 4.2% of those who received a standard cup—a roughly 70% lower relative risk and an absolute reduction of nearly 3 percentage points. Overall surgical complications were also less common with dual mobility implants, while rates of reoperation, prosthetic joint infection, mortality, health-related quality of life, and patient-reported hip function were similar between groups.

Most dislocations were managed with closed reduction rather than repeat surgery, underscoring the potential clinical value of preventing this common complication. Although dual mobility implants cost more than conventional cups, the authors note that their use could reduce the burden of postoperative instability and associated healthcare utilization.

"Our findings are likely to be widely generalisable to patients with a displaced femoral neck fracture treated with total hip replacement," the investigators wrote, citing the trial's pragmatic design across diverse hospitals and surgical practices.

Source: Hailer NP, et al. (2026 July 2) Lancet. Dual mobility versus standard cups in total hip replacement for displaced femoral neck fractures (Duality): an international, multicentre, randomised, controlled, superiority trial