A large international clinical trial led by Queen Mary University of London and Uppsala University in Sweden has found that a new type of hip replacement implant dramatically reduces complications for people who have suffered a hip fracture.
This study lancet, 1,600 patients across 44 hospitals in the UK and Sweden participated. The DUALITY trial is the largest clinical trial comparing dual-mobility total hip replacement (DM-THR) to standard total hip replacement (THR). The research team found that people treated with DM-THR were 70 percent less likely to experience postoperative dislocation, the most common complication after hip replacement for fractures.
Hip fractures in older adults are one of the most common serious injuries worldwide, affecting more than 14 million people each year and accounting for 1.4% of direct medical expenditures in established market economies. The types of hip fractures studied in the DUALITY trial account for approximately half of all hip fractures experienced worldwide.
Total hip replacement, which replaces both the ball and socket of the hip, is recommended for older, more active people with some types of hip fractures. For most patients, this surgery improves mobility and quality of life, but postoperative dislocations are common and can have serious consequences for affected patients. When a dislocation occurs, patients often require emergency hospitalization, procedures to put the joint back together, or even further surgery. This can lead to longer recovery times, more pain, and an increased risk of developing further health problems.
Dual Mobility-THR uses a small ball wrapped in a much larger plastic ball and was specifically developed to reduce the risk of dislocation. In the DUALITY trial, the team aimed to see if DM-THR reduced the risk of dislocation compared to THR. The results showed that the DM-THR implant improved hip stability and was less likely to dislocate after surgery. The researchers found that only 1.3 percent of patients who underwent DM-THR experienced a dislocation within one year after surgery, compared to 4.2 percent of those who underwent standard THR. Importantly, the study found no other increased risks such as infection or death, and patients who underwent DM-THR had lower overall complication rates.
The researchers concluded that dual mobility implants should be considered the preferred option for eligible older patients undergoing total hip arthroplasty after a hip fracture. Importantly, DM-THR requires no new technology or training. Surgeons are already familiar with both types of implants, so this change could be implemented quickly within existing practices.
Study author Professor Xavier Griffin, Director of the Center for Bone and Joint Health at Queen Mary University of London and Honorary Consultant Orthopedic Surgeon at Barts Health NHS Trust, said:
“Dislocation is the most common major complication after hip replacement surgery for hip fractures. People who experience this painful complication often require further surgery, and the subsequent recovery is usually long, slow, and painful. So, along with surgeons around the world, I recommend this type of hip replacement for people who have fractured their hips. I’ve been wondering if there’s any benefit to using joint replacement surgery. The great news from DUALITY is that we can significantly reduce the risk. We hope this research makes a real difference.” We’re grateful for the many future patents that could help us avoid this devastating problem.
I have tried to perform similar studies before, but I was never able to provide a large enough study to give a reliable answer to the question. Meeting the team in Uppsala and making this international collaboration a reality has been a game-changer in how quickly answers to these types of questions can be found. ”
Study author Professor Nils Heiler, Head of Orthopedic Surgery at Uppsala University and Consultant Orthopedic Surgeon at Uppsala University Hospital, said:
“After years of analyzing registry data and recognizing both the benefits and limitations of dual-mobility hip replacement, I was eager to have solid evidence for or against this concept. In collaboration with colleagues at Queen Mary, we successfully conducted a large-scale pragmatic orthopedic randomized trial involving both small hospitals and major referral centers in two countries.
“These results provide strong support for the use of dual-mobility constructs in hip fracture patients requiring total hip arthroplasty. Beyond the study results themselves, we believe this collaboration will set a new benchmark for future randomized trials in European orthopedic research, and we will continue to work towards that goal jointly.”
In addition to improving patient outcomes, researchers say reducing dislocations could have a major impact on health care systems. Complications such as postoperative dislocations lengthen hospital stays, require additional surgical time, and result in unplanned readmissions. Although dual-mobility implants are currently more expensive than standard implants, researchers believe that fewer complications can offset the higher initial cost. A full economic analysis is underway.
sauce:
Queen Mary University of London
Reference magazines:
Haler, North Carolina; others. (2026) Dual Mobility and Standard Cup (Duality) in Total Hip Arthroplasty for Displaced Femoral Neck Fractures: An International Multicenter Randomized Controlled Superiority Trial. lancet. DOI: 10.1016/S0140-6736(26)00759-2. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00759-2/fulltext
