Does Stem Design Affect the Incidence of Periprosthetic Femoral Fractures in Arthroplasty for Femoral Neck Fractures? A Secondary Analysis of the HEALTH Trial
Version 2 2025-03-28, 03:02
Version 1 2025-03-27, 04:33
journal contribution
posted on 2025-03-28, 03:02 authored by Panayiotis D Megaloikonomos, Lauren Nowak, Michael Shehata, Sheila Sprague, Sofia Bzovsky, Laura M Epure, Gianni De Petrillo, Camille Caron, George Laggis, Olga L Huk, David J Zukor, Mohit Bhandari, Emil H Schemitsch, John Antoniou, Thomas A Einhorn, Gordon H Guyatt, Robert D Zura, Frede Frihagen, Ernesto Guerra-Farfán, Ydo V Kleinlugtenbelt, Rudolf W Poolman, Amar Rangan, Diane Heels-Ansdell, Lehana Thabane, Stephen D Walter, PJ Devereaux, Kenneth J Koval, Kevin Tetsworth, Paula McKay, Kim Madden, Kerry Tai, Taryn Scott, Marilyn Swinton, Naveen Khan, Lisa Buckingham, Aravin Duraikannan, Heather Silva, David Novikov, Daniel P Waren, Ellie BM Landman, Martin J Heetveld, Esther MM Van Lieshout, Paul TPW Burgers, Birgit Hanusch, Lucksy Kottam, Victoria Avram, Ajay Manjoo, Tim Ramsay, Earl R Bogoch, Andrew Trenholm, Stephen Lyman, Madhu Mazumdar, Kevin J Bozic, Mark Luborsky, Stuart Goodman, Susan Muray, Benjamin K Potter, Nathan N O’Hara, Gerard P Slobogean, Quazi Ibrahim, Richard Buckley, Robert Korley, Paul Duffy, Shannon Puloski, Eldridge Batuyong, Christopher Martin, James MacKenzie, Jason Werle, Kelly Johnston, Neil White, Marcia Clark, Gregory Abelseth, Stephen Hunt, Justin LeBlanc, Prism Schneider, Kimberly Carcary, Ross McKercher, Lisa Murphy, Melissa Lorenzo, Tanja Harrison, Leah Schultz, Aftab Akbari, Stephanie Yee, Tina Samuel, Saboura Mahdavi, Trevor B Stone, Bertrand Perey, Farhad Moola, Darius Viskontas, Kelly Apostle, Dory Boyer, H Michael Lemke, Robert McCormack, Mauri Zomar, Bindu Mohan, Karyn Moon, Raely Pritchard, Brenda Chen Fan, Kyrsten Payne, Aaron Nauth, Michael D McKee, Jeremy A Hall, Daniel Whelan, Sarah Ward, David Walmsley, James P Waddell, Henry Ahn, Timothy R Daniels, Milena R Vicente, Jennifer T Hidy, Melanie T MacNevin, Paril Suthar, Hans Kreder, David Stephen, Richard Jenkinson, Markku Nousiainen, Terry Axelrod, Veronica Wadey, Sebastian Tomescu, Monica Kunz, Katrine Milner, Melanie MacNevin, Ria De Gorter, Wesley Ghent, Fathima Adamsahib, Araby Sivananthan, Aimee Theriault, Michelle Arakgi, Phumeena Balasuberamaniam, Ravi Tuazon, Peter J O’Brien, Piotr A Blachut, Henry M Broekhuyse, Pierre Guy, Kelly A Lefaivre, Dean G Malish, Raman Johal, Jessica Peattie, Abdullah Mamun, Benita Okocha, Irene Leung, Étienne Belzile, Luc Bedard, Martin Bédard, Bernard Laliberté, Jean Lamontagne, Martin Lesieur, Luc Petitclerc, Marie-ève Roger, Stéphane Pelet, Luc Lemire, Hélène Côté, Chad Coles, Ross Leighton, C Glen Richardson, Michael Biddulph, Michael Gross, Michael Dunbar, J David Amirault, David Alexander, Catherine Coady, Mark Glazebrook, David Johnston, William Oxner, Gerald Reardon, Ivan Wong, Kelly Trask, Shelley MacDonald, Andrew Furey, Craig Stone, Keegan Au, William Moores, Peter Rockwood, Carl Moores, Daniel Squire, Sarah Anthony, Minnie Parsons, Valisha Keough, Erin Baker, Samir Chhabra, Osama Gharsaa, Abdulmajid Ibrahim, Esmat Dessouki, Omar Dessouki, Aileen Manganaro, Kelly Fusco, François Marquis, Annie Arteau, Marc Bouchard, Alexandre Leclerc, Michèle Angers, Sylvain Belzile, Sylvie Turmel, G-Yves Laflamme, Benoit Benoit, Pierre Ranger, Michel Malo, Julio Fernandes, Julie Fournier, Karine Tardif, Robert J Feibel, Hesham Abdelbary, Christopher Kennedy, Paul Kim, Paul Beaule, Joel Werier, Alberto Carli, Peter Lapner, Geoff Dervin, Katie McIlquham, Sara A Ruggiero, Carly St. Germain, Heather Cosgrove, Johanna Dobransky, Cheryl Kreviazuk, Sebastian Rodriguez-Elizalde, Anna Rose Soliman, Sagar Desai, John Townley, Iriss Mariano, Theresa B Pedutem, Mary June Francisco, Andrew Marcantonio, Michael Kain, Lawrence Specht, John Tilzey, John Garfi, Andrew Sems, Tab Mabry, Joseph Cass, Michael Torchia, William Cross, Michael Taunton, Joaquin Sanchez-Sotelo, Rafael Sierra, Barbara Foreman, Franklin D Shuler, James Day, Tigran Garabekyan, Felix Cheung, Ali Oliashirazi, Jonathon Salava, Linda Morgan, Timothy Wilson-Byrne, Grant Buchanan, Milad Modarresi, Mary Beth Cordle, Brian Mullis, Karl Shively, Andrew Parr, Janos Ertl, Ripley Worman, Mark Webster, Judd Cummings, Valda Frizzell, Molly Moore, Kenneth A Egol, Nirmal C Tejwani, Roy I Davidovitch, Ran Schwarzkopf, Jonathan M Vigdorchik, James D Slover, Sanjit R Konda, Toni M McLaurin, Pankajkumar Patel, Clifford B Jones, James R Ringler, Debra L Sietsema, Carlos Sagebien, David Harwood, Stephen Kayiaros, Patricia Seuffert, Russell Meldrum, Sarim S Ahmed, Enes Kanlic, Amr Abdelgawad, Juan Shunia, Samir Mehta, John L Esterhai, Jaimo Ahn, Derek Donegan, Atul Kamath, Neil Sheth, Annamarie Horan, Patrick Hesketh, Thomas Rose, Rachel Reilly, Steven Olson, Kendra Marr, Maria Manson, Cameron Howes, Benjamin M Stronach, Patrick F Bergin, Jennifer S Barr, Clay A Spitler, Josie M Hydrick, Leslie N Johnson, Paul Tornetta, William R Creevy, Michelle J Lespasio, Hope Carlisle, Craig Davis, Philip Stull, Stewart Weinerman, Peter Weingarten, Steven Lindenbaum, Michael Hewitt, Rebecca Danielwicz, Janell Baker, Charles DePaolo, Christina Riggsbee, Tracey Nanney, Gregg Strathy, Kathleen Peter, Paul Johnson, Meaghan Morton, Michael Mont, Ronald E Delanois, Bhaveen Kapadia, Kimona Issa, Marylou Mullen, Mark Anders, Christopher Mutty, Matthew Phillips, Sridhar Rachala, Mary Bayers-Thering, Timothy J Sauber, Edward Westrick, Joseph Guth, Michael H Maher, Thomas F Higgins, Erik N Kubiak, Jeremy Gililland, David Rothberg, Christopher Peters, Christopher Pelt, Ami R Stuart, Kirby Corbey, Ashley Neese, Mark T Russell, Victor Solis, Andrea Gurule, David Zamorano, John A Scolaro, Douglas Kiester, Deeba Pourmand, Tyson T Schrickel, John V Gentile, Barbara M Hileman, Elisha A Chance, Javad Parvizi, Tiffany Morrison, James Roberson, Thomas Bradbury, Greg Erens, Kyle Webb, Michael Dohm, Cindy Fastje, José Luis Camarena, Maria Gordon, Hans-Peter W van Jonbergen, Willem H Roerdink, Joost M Reuver, Alexander FW Barnaart, Elvira R Flikweert, Danielle D Langeloo, Rinco CT Koorevaar, Leon HGJ Elmans, Joost AAM van den Hout, Adrianus JP Joosten, Ad FA van Beurden, Stefan BT Bolder, Denise Eygendaal, Adrianus FCM Moonen, Rutger CI van Geenen, Eric A Hoebink, Robert Wagenmakers, Wouter van Helden, Harm M van der Vis, Lijkele Beimers, Jasper de Vries, Arthur W Zurcher, GH Rob Albers, Maarten Rademakers, Stefan Breugem, Ibo van der Haven, Pieter Jan Damen, Gythe H Bulstra, Martin M Campo, Bauke W Kooistra, Willem Jan Kleyn Molekamp, Frank RAJ de Meulemeester, Arthur EB Kleipool, Robert Haverlag, Maarten P Simons, Eduard LAR Mutsaerts, Diederik HR Kempen, Mark C Altena, Dirk JF Moojen, John SJ Ham, Arnard van der Zwan, Michel PJ van den Bekerom, Vanessa AB Scholtes, Mariëlla EM Volkers, Amanda D Klaassen, Loes WAH van Beers, Nienke W Willigenburg, Ihsan Amajjar, Sven H van Helden, RG Zuurmond, Adriaan Mostert, P Houben, G Solinge, WR Spanjersberg, R Nijveldt, K van Egmond, Lonneke Buitenhuis, Hugo W Bolhuis, Pieter HJ Bullens, Mike Hogervorst, Karin E de Kroon, Rob H Jansen, Ferry Steenstra, Eric EJ Raven, Tjitte de Jong, Arthur van Noort, Diederik A Vergroesen, Bernard G Schutte, Rover Krips, J Bernard Mullers, Hans Schüller, Stefan B Keizer, Jan-Willem A Swen, Peter HC den Hollander, Bregje JW Thomassen, W Peter J Fontijne, Saskia C Wiersma, Bastiaan Boetes, Edgar JT ten Holder, Rob Kooijman, Roelf R Postema, René JTM Bleker, Harald IH Lampe, Lein Schuman, John Cheung, Frank van Bommel, Daniel Haverkamp, Harm van der Vis, Huub JL van der Heide, Jochem Nagels, Enrike HMJ van der Linden-van der Zwaag, Jan P van Dijk, Wouter H van Helden, Mark LM Falke, Frans J Kurek, Adrianus CH Slingerland, Ernesto Guerra Farfán, Jordi Teixidor SerraBackground
The aim of this study was to evaluate how stem design influences the risk of periprosthetic femoral fractures (PFFs) after hemiarthroplasty (HA) and total hip arthroplasty for femoral neck fractures.
Methods
We performed a secondary analysis of the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty trial, a multicenter, prospective, randomized control trial that assessed total hip arthroplasty versus hemiarthroplasty for low-energy femoral neck fractures. Between 1,374 patients (414 men, 960 women) that were assessed, 72 sustained PFFs (5.2%). Intraoperative PFFs were recorded in 42 patients, early postoperative PFFs in 15 and late PFFs in 15 patients. The incidence of PFFs was compared between cemented and cementless stems. Within the cemented group (n = 896), we analyzed the effect of taper-slip (n = 482) versus composite-beam (n = 414) designs, while within the cementless group (n = 478), we assessed the impact of single-wedged (n = 206) versus metaphyseal-filling stems (n = 272). The role of collars (n = 87) was also examined within the press-fit stems. Clinical outcomes were recorded with the Western Ontario and McMaster Universities Arthritis Index
Results
Cemented stems had a significantly lower incidence of PFFs than their cementless counterparts (2.6 versus 10.3%, P < 0.001). There was no difference in fracture rates between taper-slip and composite-beam stems (2.3 versus 2.9%, P > 0.05). Most of the composite-beam PFFs occurred intraoperatively (75%), while most of the taper-slip PFFs occurred late (55%). There was no difference between the. press-fit stems, while the presence of a collar did not show protective results (P > 0.05). Patients who underwent HA with taper-slip stems demonstrated inferior Western Ontario and McMaster Universities Arthritis Index scores and higher incidence of reoperation for pain than those treated with composite-beam stems (2.6 versus 0.4%, P = 0.048).
Conclusions
Cementless stems have a high PFF rate, regardless of the stem type or presence of collar. Taper-slip stems are responsible for late fractures, raising concerns about their performance in the long term. Patients treated with HA may present a higher risk of reoperation for pain when taper-slip stems are used.
