Lamb, J.N., West, R.M., Relton, S.D. et al. (2 more authors) (2025) The Risk of Postoperative Periprosthetic Femoral Fracture After Total Hip Arthroplasty Depends More on Stem Design Than Cement Use: An Analysis of National Health Data from England. Journal of Bone and Joint Surgery, 107 (5). pp. 476-487. ISSN 0021-9355
Abstract
Background: In this study, we estimated the risk of surgically treated postoperative periprosthetic femoral fractures (POPFFs) associated with femoral implants frequently used for total hip arthroplasty (THA).
Methods: In this cohort study of patients who underwent primary THA in England between January 1, 2004, and December 31, 2020, POPFFs were identified from prospectively collected revision records and national hospital records. POPFF incidence rates, adjusting for potential confounders, were estimated for common stems. Subgroup analyses were performed for patients >70 years of age, with non-osteoarthritic indications, and with femoral neck fracture.
Results: POPFFs occurred in 0.6% (5,100) of 809,832 cases during a median follow-up of 6.5 years (interquartile range [IQR], 3.9 to 9.6 years). After cemented stem implantation, the majority of POPFFs were treated with fixation. Adjusted prosthesis time incidence rates (PTIRs) for POPFFs varied by stem design, regardless of cement fixation. Cemented composite beam (CB) stems demonstrated the lowest risk of POPFF. Collared cementless stems had an equivalent or lower rate of POPFF compared with the current gold standard of a polished taper slip cemented stem.
Conclusions: Cemented CB stems were associated with the lowest POPFF risk, and some cementless stem designs outperformed modern cemented stem designs. Stem design was strongly associated with POPFF risk, regardless of the presence of cement. Surgeons, policymakers, and patients should consider these findings when considering femoral implants in those most at risk for POPFF.
Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2025 by The Journal of Bone and Joint Surgery, Incorporated. This is an author produced version of an article published in Journal of Bone and Joint Surgery. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 04 Dec 2024 10:41 |
Last Modified: | 24 Mar 2025 15:32 |
Status: | Published |
Publisher: | Lippincott, Williams & Wilkins |
Identification Number: | 10.2106/JBJS.24.00894 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:220406 |
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Filename: The risk of post-operative periprosthetic femoral fractures after total hip arthroplasty is more dependent on stem design features than the presence or absence of c.pdf
