Does the Periprosthetic Fracture Pattern Depend on the Stem Fixation Method in Total Hip Arthroplasty?

Area of Science:

• Orthopedic Surgery
• Biomaterials Engineering
• Medical Device Design

Background:

• Periprosthetic femoral fractures (PFFs) pose significant management challenges in revision hip arthroplasty.
• Fracture patterns and clinical outcomes may differ based on stem fixation (cemented vs. cementless) and fracture characteristics.

Purpose of the Study:

• To compare fracture patterns and clinical outcomes in patients with PFFs treated with tapered fluted modular stems (TFMSs).
• To investigate associations between stem fixation type (cemented vs. cementless) and PFF characteristics and outcomes.

Main Methods:

• Retrospective comparative study of 52 patients with Vancouver B2 or B3 PFFs treated with TFMSs.
• Analysis of fracture patterns and bone stock in 21 cemented and 31 cementless stem groups.
• Comparison of clinical outcomes, including subsidence, union, and complications, between the two groups.

Main Results:

• Transverse/oblique PFFs and Paprosky type III/Vancouver B3 fractures were more common with cemented stems.
• Spiral fractures were more frequent around cementless stems (p < 0.001).
• Excessive subsidence (>5 mm) and higher re-revision rates occurred more frequently in the cemented group (p < 0.001, p = 0.047).

Conclusions:

• Cemented stems are associated with transverse/oblique PFFs, while cementless stems correlate with long spiral fractures.
• PFFs around cemented stems show increased stem subsidence and reoperation rates compared to cementless stems.