ArticleJournal of orthopaedic case reports2025
Femoral Stem Subsidence Rate with Cementless Stems in Patients with Sub-capital Femoral Neck Fractures: Relationship to Proximal Femoral Geometry.
Article in Journal of orthopaedic case reports, 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
Introduction: Hip joint replacement surgeries, including total hip arthroplasty (THA) and hemiarthroplasty (HA), are highly successful for treating subcapital femoral neck fractures. However, femoral stem subsidence can negatively impact post-operative outcomes. This study investigates subsidence rates in relation to the geometry of the proximal femur. Methods: A total of 255 patients who underwent cementless HA or THA were included, with follow-up data available for 74 patients who met the inclusion criteria. Pre- and post-operative variables included surgery type, age, sex, ASA score, and rehabilitation method. The cohort was divided into two groups based on femoral stem migration: a low subsidence group (0-4.99 mm) and a high subsidence group (>5 mm). Further subdivision was done according to the proximal femur morphology, which was classified by the Dorr Classification. Results: 44 patients (or 59.5%) were classified as Dorr type A, 27 patients (or 36.5%) were type B, and only three patients (4.1%) were type C. Among patients with Dorr type A, 79.5% had low subsidence, while 20.5% had high subsidence. In Dorr type B, subsidence was nearly equal (51.9% low, 48.1% high). Two Dorr type C patients had low subsidence (66.6%), and one had high subsidence (33.3%). Results were statistically significant (P = 0.042). Multivariate analysis showed that type A patients were likelier to have low subsidence (OR 3.403, CI 1.221-9.486, P = 0.022). Conclusion: The subsidence rate of cementless femoral stems was lower in patients with type A Dorr classification compared to types B and C. These findings suggest that structural geometric differences between the classifications may significantly affect susceptibility to subsidence.
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