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Dual-mobility bearings associated with threefold reduction in dislocation risk in high-risk hip arthroplastyDual mobility bearings show lower risk of hip joint dislocation

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Key Takeaway
Note that dual-mobility bearings showed a threefold reduction in dislocation risk, but did not reach statistical significance.

This multicenter randomized controlled trial enrolled 555 patients at high risk of dislocation following primary total hip arthroplasty. Patients were randomized to receive either dual-mobility (DM) bearings (n=271; 42 mm mean effective head) or single bearing (SB) femoral heads (n=284). The median follow-up period was 23 months (range, 3.0 to 87.2).

The primary outcome was the incidence of dislocations. The DM group recorded 2 dislocations (0.7%) compared to 6 in the SB group (2.1%). This represented a threefold reduction in risk, but the result was not statistically significant (P = 0.29). Secondary outcomes included 2-year dislocation-free survivorship (99.0% vs 97.6%, P = 0.63) and 2-year all-cause revision-free survivorship (97.5% vs 96.4%, P = 0.53). No significant differences were observed in patient-reported outcome measures at any time point (P > 0.05).

Safety data showed 2 infections in the DM group (0.7%) and 5 in the SB group (1.8%). A total of 16 hips were revised (2.2% in DM vs 3.5% in SB; P = 0.45). The study noted that the lower than anticipated overall dislocation rate in both groups resulted in a lack of statistical significance. Further follow-up is required to capture late dislocations or instability. Clinical evidence for DM bearings is currently limited by these low overall event rates.

How this fits prior evidence

How this fits prior evidence: This study addresses the management of patients with hip instability. While a previous retrospective study linked SMA type 1 to a higher hip instability prevalence in children, this trial evaluates the efficacy of dual-mobility bearings specifically for patients at high risk of dislocation following primary total hip arthroplasty.

When a person receives a total hip replacement, the biggest fear is often the joint popping out of place, known as a dislocation. This is especially concerning for patients at high risk for instability. Researchers tracked 555 patients to see if using dual mobility bearings—a specific type of joint design—offered better protection than standard single bearing heads.

In the study, the dual mobility group saw only 2 dislocations compared to 6 in the single bearing group. While this showed a threefold reduction in risk, the overall rates were low enough that the difference was not statistically significant. Other measures, including the rate of surgery revisions and patient-reported outcomes, showed no significant differences between the two types of implants.

Because the study followed patients for a median of 23 months, the researchers noted that more time is needed to catch late dislocations. While the dual mobility design showed a lower number of dislocations in this group, the results are currently considered an association rather than a definitive proof of superiority.

What this means for you:
Dual mobility hip implants showed a threefold reduction in dislocation risk, but more long-term data is needed.

Common questions

What is a dual mobility bearing?

A dual mobility bearing is a specific type of joint design used in hip replacements. In this study, it was compared to a standard single bearing head to see which design performed better for patients at high risk of the joint popping out of place.

How many dislocations occurred in each group?

In the study of 555 patients, the dual mobility group had 2 dislocations, while the single bearing group had 6. This represented a threefold reduction in risk for the dual mobility group, though the difference was not statistically significant.

Are there any risks or side effects reported?

The study reported infections in both groups: 2 cases in the dual mobility group and 5 in the single bearing group. However, there were no significant differences in other safety outcomes or patient-reported results between the two types of implants.

Study Details

Study typeRct
Sample sizen = 271
EvidenceLevel 2
Follow-up900.0 mo
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: This multicenter randomized controlled trial sought to determine if dual-mobility (DM) bearings reduce dislocations in patients at high-risk for instability undergoing primary total hip arthroplasty compared to single bearing (SB) femoral heads. METHODS: A total of 555 patients undergoing primary posterior approach total hip arthroplasty were randomized to DM (n = 271; 42 mm mean effective head, range 36 to 55) or SB heads (n = 284; 28 mm [n = 2], 32 mm [n = 42], 36 mm [n = 168], 40 mm [n = 61], 44 mm [n = 11]). High-risk criteria included the following: prior lumbo-sacral fusion (n = 170) or other inclusions (age ≥ 75 years , preoperative combined flexion-adduction-internal rotation ≥ 115°, substance abuse, inflammatory arthritis, neuromuscular disorder, removal of hardware, cognitive impairment, acute displaced femoral neck fracture, and kyphosis/scoliosis; n = 385). There were 28 patients (5.0%) lost to follow-up before 90 days, leaving 527 patients followed for a median of 23 months (range, 3.0 to 87.2). RESULTS: There were two dislocations in the DM group and six in the SB group (0.7 versus 2.1%, P = 0.29). There was no difference in 2-year dislocation-free survivorship between cohorts (DM: 99.0 versus SB: 97.6%; P = 0.63). There were 16 hips revised (DM: 2.2 versus SB: 3.5%; P = 0.45), with no difference in 2-year all-cause revision-free survivorship (DM: 97.5 versus SB: 96.4%; P = 0.53). Infection was the most common revision indication (two DM [0.7%] versus five SB [1.8%]). There were no differences in patient-reported outcome measures at any time point (P > 0.05). CONCLUSION: In this multicenter randomized controlled trial, DM bearings were associated with a threefold reduction in dislocation risk, but given the lower than anticipated overall dislocation rate, this difference did not reach statistical significance. Further follow-up is required to capture late dislocations or instability.
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