ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025
1000 collared cementless femoral stems: periprosthetic fracture rates in 500 THA versus 500 hemiarthroplasties.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThis study investigates the claim that the majority of elderly patients undergoing elective total hip arthroplasty (THA) that would routinely be treated with a collared cementless stem are just one fall away from a neck of femur fracture that would then commit them to a cemented femoral prosthesis in many other institutions. This study aims to compare the incidence of intra-operative periprosthetic fracture (PPF) and early postoperative PPF using a cementless collared femoral stem between 500 consecutive elective total hip arthroplasty (THA) patients and 500 consecutive neck of femur (NOF) fracture patients treated with a hemiarthroplasty.
methodsThis was a single-institution retrospective cohort study between August 2015 and December 2023 assessing 500 consecutive NOF fractures and 500 consecutive elective THAs treated with a single brand of collared cementless femoral stem. The primary outcome measure was intra-operative PPF. Secondary outcome measures included early PPF, defined as PPF within 90 days of initial surgery and 90-day mortality.
resultsThe mean age in the THA group was 66 (range 32-94) with 246/500 (49.2%) patients being female. In the NOF group, the mean age was 80 (range 45-102) with 350/500 (70%) of patients being female. In the THA group, seven (1.4%) of patients sustained an intra-operative fracture compared with 15 (3%) patients in the NOF group (p = 0.09). There were three (0.6%) early PPFs in the elective group compared to four (0.8%) in the NOF group (p = 0.7). The 90-day mortality was zero in the elective group and 8.8% in the NOF group. None of the NOF patients with an intra-operative fracture died at the time of follow-up.
conclusionCollared cementless femoral stems are safe for use in hemiarthroplasty for hip fracture, especially in an institution that performs cementless HA as standard practice for all hip fractures requiring hemiarthroplasty.
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