Conference Coverage

Dual Mobility THA Does Not Reduce Revision After Hip Fracture

Edited by:
Ashton L. Stahl

Key Highlights

  • The DISTINCT trial enrolled 2,440 patients across 50 Australian hospitals.
  • Dual mobility total hip arthroplasty did not significantly reduce 2-year revision risk for all causes, dislocation, or fracture compared with conventional implants.
  • Too few revisions for infection and loosening occurred to permit meaningful comparisons.

In patients with femoral neck fractures, dual mobility total hip arthroplasty (THA) did not reduce revision surgery compared with conventional THA, according to the DISTINCT randomized controlled trial. The abstract, provided for the American Association of Hip and Knee Surgeons 2026 Annual Meeting, reported no significant differences in all-cause revision or revision for dislocation or fracture at 2 years.

The investigators conducted a multicenter, cluster-randomized, crossover, open-label trial nested within the Australian Orthopaedic Association National Joint Replacement Registry. Fifty hospitals in Australia were randomized to perform conventional or dual mobility THA. Eligible patients were older than 50 years and suitable for THA to treat a femoral neck fracture. Recruitment occurred from February 1, 2021, through December 31, 2023, with final follow-up on December 31, 2025. The primary outcome was 2-year revision for any cause and for dislocation, infection, fracture, or loosening. The primary analysis used intention-to-treat cluster summary methods.

Study Findings

The trial enrolled 2,440 eligible patients: 1,212 in the conventional THA group and 1,228 in the dual mobility group. Mean age was 73 years (SD, 8.9), and 1,664 patients (68.2%) were female. The abstract reported 1,474 procedures performed through a posterior approach, 505 through a lateral approach, and 173 through an anterior approach.

Overall, 58 revisions (2.4%) occurred during the study period. At 2 years, the investigators found no significant between-group differences in all-cause revision (P = .35), revision for dislocation (P = .32), or revision for fracture (P = .07). Revisions for infection and loosening were too few to allow meaningful comparisons. The revision risk difference between conventional and dual mobility THA did not vary between posterior and non-posterior surgical approaches.

Clinical Implications

According to the study authors, dual mobility THA does not protect against revision surgery in patients with femoral neck fractures. The trial examined whether dual mobility implants could reduce revision risk in this population, where the investigators identified dislocation as the leading cause of revision after THA.

Expert Commentary

After comparing dual mobility and conventional implants across 50 Australian hospitals, the investigators found no significant difference in 2-year revision risk. “DM THA does not protect against revision surgery in FNF patients,” the researchers concluded.

Reference

Wall C, DISTINCT Study Group, Garden F, et al. DISTINCT RCT: dual mobility vs. conventional total hip arthroplasty in femoral neck fractures. Paper #30. Abstract presented at the American Association of Hip and Knee Surgeons Annual Meeting, November 5–8, 2026, Dallas, TX.