Reduced long-term periprosthetic fracture rates with composite beam versus polished tapered stems in cemented hip arthroplasty : a ten-year observational study.

Abstract

This study evaluates the effect of an orthopaedic department's full transition from the use of a cemented polished tapered stem (PTS) to a cemented composite beam femoral component (CB) on periprosthetic fracture rates up to ten years after primary surgery. A ten-year, prospective observational study was conducted on patients undergoing cemented hip arthroplasty. There were 542 patients in the PTS group and 534 in the CB femoral component group. There were 333 and 285 hemiarthroplasties in the PTS and CB groups, respectively. The mean age of participants was 82 years (SD 8.1). The majority of patients were classified as American Society of Anesthesiologists (ASA) grade III to IV and were female, comprising 71.2% in the PTS group and 74.5% in the CB group. Most patients, 827, underwent hip arthroplasty due to fractures (76.9%). Cognitive dysfunction was present in 27% (n = 142) to 29% (n = 159) of patients. Cox regression analysis was performed to adjust for confounders such as age, sex, ASA grade, and cognitive dysfunction. The PTS group had a higher rate of periprosthetic fractures (6.5%) compared with the CB group (1.3%) over the study period from November 2011 to December 2015. The reoperation rate for the PTS groups was 9.7% and 5.2% for the CB group, respectively. The dislocation rates were 4.9% for the PTS and 1.3% for the CB group. The periprosthetic joint infection rate was 3.5% in the PTS and 2.0% in the CB group. In the regression model female sex (HR 2.0, 95% CI 1.2 to 3.1), ASA grade (HR 3.2, 95% CI 1.1 to 8.3), cognitive dysfunction (HR 1.9, 95% CI 1.2 to 3.2), and the type of femoral component (PTS vs CB, HR 0.2, CI 0.1 to 0.3) were correlated with outcome. CB femoral components were associated with a reduction in adverse events compared with PTS in cemented hip arthroplasty in an older population. These findings support the use of CB femoral components in order to improve patient outcomes and minimize complications in selected cases.