global mutex locks will fail if Apache used semaphores because requests against different virtual hosts run as different users and user will not have permission to access the semaphore to lock it. See:
If available MPMs with such constraints are going to appear, may make sense to have an option to configure which allows one to override at compile time the default mechanism used for global mutex locks so that it can be made to match what may be required for a specific MPM that Apache is compiled to use.