Incidence of periprosthetic femoral fracture after total hip arthroplasty using the exeter stem: A retrospective multicenter cohort study in Japan.

Abstract

Periprosthetic femoral fracture is a serious complication following total hip arthroplasty. Compared with composite-beam stems, polished taper-slip stems have been reported to carry a higher risk of periprosthetic femoral fractures. However, long-term multicenter data on the incidence of periprosthetic femoral fractures following cemented and hybrid total hip arthroplasty using the Exeter polished taper-slip stem, particularly in Japan, remain limited. A retrospective multicenter cohort study using registry data from seven Exeter teaching hospitals in Japan was conducted. A total of 8499 primary cemented and hybrid total hip arthroplasties performed between 1999 and 2021 were analyzed. Postoperative periprosthetic femoral fractures were identified and classified according to the Vancouver classification. Treatment modalities-including conservative management, open reduction and internal fixation, and revision arthroplasty-were evaluated. Patient- and implant-related factors were compared between patients with and without periprosthetic femoral fractures, and multivariable logistic regression analysis was performed. A total of 22 postoperative periprosthetic femoral fractures were identified, yielding an incidence of 0.26% (95% confidence interval, 0.16-0.39%). The median time to fracture was 8.1 years (interquartile range, 2.7-12.0). Most fractures were classified as Vancouver types B1, B2, and C. Atypical fracture morphologies associated with polished taper-slip stems, such as sickle-type or axe-splitter patterns, were rarely observed. Half of the fractures were treated with open reduction and internal fixation, and one-third required revision arthroplasty. Cement-in-cement revision was feasible in most revision cases. This multicenter study demonstrated a very low incidence of long-term periprosthetic femoral fractures following cemented and hybrid total hip arthroplasty using the Exeter stem. These findings underscore the reliability of polished taper-slip designs; however, further validation in larger, and more diverse populations is warranted.