Increased frequency of dislocation following total hip arthroplasty for trauma

Aims The purpose of this study was to compare surgical techniques and postoperative outcomes in an age- and sex-matched cohort of patients undergoing total hip arthroplasty (THA) for neck of femur fracture (#NOF) and for osteoarthritis (OA). Methods A single-centre, consecutive series of patients at minimum one-year follow-up following THA for #NOF were compared with a 1:1 age- and sex-matched cohort of patients following THA for osteoarthritis from the same institution. The primary outcome measure was frequency of dislocation at one year postoperatively. Secondary outcomes included rates of all-cause revision, infection, periprosthetic fracture, and mortality at one year and medium-term postoperatively. Cox regression compared medium-term outcomes between groups, accounting for unequal follow-up duration. Results A total of 722 patients were included, with 361 in each group. BMI was greater in the OA group (28.9 kg/m 2 vs 24.7 kg/m 2 ; p < 0.001). Sex, age, American Society of Anesthesiologists grade, and comorbidity profile did not differ between groups (p > 0.247). Overall, 151 patients (41.8%) in the #NOF group received dual-mobility implants, compared with eight (2.2%) in the OA group (p < 0.001). Femoral offset was similar between groups (42.6 mm and 42.7 mm, p = 0.892). Dislocation rates were greater in the #NOF group than the OA group at one-year (4.4% vs 1.1%; p = 0.011) and by final follow-up. The one-year rates of periprosthetic fracture, all-cause revision, and mortality were similar between groups (p > 0.340), although risk of mortality was greater by final follow-up after THA for #NOF (hazard ratio 1.577; p = 0.033). Conclusion Despite the more frequent use of dual-mobility implants in THA for #NOF than OA and the otherwise comparable patient demographics and implants used, the risk of early dislocation after THA for #NOF was four times greater than in an age- and sex-matched elective THA cohort. Early postoperative complication rates were otherwise comparable between the groups. Cite this article: Bone Jt Open 2026;7(11):1455–1461.