Periprosthetic femoral fracture following hip arthroplasty : which component design and fixation method has the lowest risk of reoperation?

Abstract

Periprosthetic femoral fracture (PPFF) is a major complication following hip arthroplasty. This study examined the influence of femoral component design and fixation method on the risk of reoperation for PPFF. We analyzed data on femoral component type use for primary hip arthroplasty stems reported to the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register from 1 January 2005 to 31 December 2023. The study included 187,576 well-documented femoral components used in hemi- and total hip arthroplasties which were assessed by Cox regression. The femoral components were categorized into five groups: 1) cemented composite beam (n = 30,415), and two types of cemented polished taper-slip components; 2) double-tapered (n = 52,255); 3) triple-tapered (n = 13,894), and two types of uncemented femoral components; 4) wedged collarless (n = 38,389); and 5) wedged collared (n = 40,853). Endpoint was reoperation for PPFF (revisions and osteosyntheses). A total of 1,398 femoral components (0.7%) were reported with a reoperation due to PPFF. The risk of reoperation was significantly higher for cemented double-tapered (adjusted hazard rate ratio (aHRR) 4.0 (95% CI 3.1 to 5.2), cemented triple-tapered (aHRR 4.0 (95% CI 2.9 to 5.6)), uncemented wedged collarless (aHRR 7.3 (95% CI 5.6 to 9.5)), and uncemented wedged collared (aHRR 3.5 (95% CI 2.6 to 4.6)) components compared to cemented composite beam components. Cemented triple-tapered prostheses exhibited a similar risk of reoperation (aHRR 1.0 (95% CI 0.8 to 1.3)) to cemented double-tapered components. Uncemented wedged collarless prostheses were associated with a higher risk of PPFF (aHRR 2.1 (95% CI 1.8 to 2.5)) compared to uncemented wedged collared designs. To minimize the risk of PPFF, cemented composite-beam femoral components should be the surgeon's preferred choice. If cementing is not an option, uncemented wedged collared components are the best alternative. Opting for a cemented triple-tapered design does not improve outcomes compared to double-tapered component.