Higher femoral periprosthetic fracture rate with dual-mobility compared with single-mobility total hip arthroplasty

Aims Dual-mobility implants have reduced dislocation rates in total hip arthroplasty (THA), particularly in high-risk populations. However, under conditions of high stress, such as a fall or forced range of motion, the energy that would otherwise cause dislocation is instead transmitted distally along the femoral component and into the surrounding bone. Therefore, concerns remain regarding their potential impact on the risk of periprosthetic fracture (PPF). Methods In a single-centre study, we retrospectively analyzed 1,415 patients who underwent uncemented THA with either a dual-mobility (DM-THA; 425 hips) or ceramic-on-ceramic (CoC-THA; 990 hips) bearing between January 2017 and December 2024. Propensity score matching (PSM) was performed for age, sex, BMI, and surgical indication, yielding a matched cohort of 260 DM-THA and 520 CoC-THA patients. Incidences of PPF, dislocation, and mortality were compared. Results PPF occurred significantly more frequently in the DM-THA group than in the CoC-THA group (4.0% (17/425) vs 0.8% (8/990); odds ratio (OR) 4.8 (95% CI 1.86 to 12.4); p = 0.001), a finding confirmed after PSM (OR 3.5 (95% CI 1.3 to 8.6); p = 0.007). Femoral neck fracture (FNF) as the surgical indication was independently associated with an increased risk of PPF in both the overall and matched cohorts. In contrast, DM-THA was associated with a significantly lower dislocation rate compared with CoC-THA after PSM (0.4% (1/260) vs 4.0% (21/520); OR 0.09 (95% CI 0.02 to 0.49); p = 0.005). FNF was also associated with a higher risk of dislocation. No significant interaction was observed between bearing type and surgical indication for either PPF or dislocation. Conclusion While DM-THA effectively reduces dislocation risk, it may be associated with a higher incidence of PPF compared with standard constructs in patients undergoing THA for FNF. These findings underscore the need to carefully weigh the risks and benefits of dual-mobility bearings. Cite this article: Bone Joint J 2026;108-B(10):1231–1237.