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Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Taper-Slip Cemented Femoral Stem Designs Are Associated With Higher Periprosthetic Fracture Risk Compared to
Foster Chen1, Heather A Prentice2, Brian H Fasig2
1Department of Orthopaedic Surgery, Washington Permanente Medical Group, Seattle, Washington.
Background:
Recent total hip arthroplasty (THA) studies have highlighted a benefit of cemented femoral fixation for reducing periprosthetic fractures (PPFs), though historically there was a concern of later aseptic loosening (AL). To date, these studies heavily concentrated on either a specific "taper slip" (TS) or "composite beam" (CB) design, with different fixation mechanisms and different implications for PPF and AL. A registry-based study was undertaken to evaluate the revision risk between these two designs.
Methods:
We conducted a cohort study using data from a US health care system's Total Joint Replacement Registry. Adult patients who underwent primary THA with a TS or CB stem, a cross-linked polyethylene liner, and a femoral head ≥ 28 mm were included (2002 to 2023). Multivariable Cox proportional hazards regressions were used to evaluate aseptic revision and revision due to PPF and AL with covariate adjustment. There were 4,631 primary cemented THAs included (1,184 TS versus 3,447 CB).
Results:
Aseptic revision incidence at 19 years was 5.4% for TS and 3.9% for CB. The PPF revision incidence was 2.7 versus 1.2%; the AL revision incidence was 0.9 versus 1.5% for TS and CB, respectively. In adjusted analyses, there was no difference in aseptic revision risk (hazard ratio [HR] = 1.38, 95% confidence interval [CI] = 0.87 to 2.20). A higher risk of PPF revision was observed with TS (HR = 3.51, 95% CI = 1.46 to 8.40), but no differences were observed for AL (HR = 0.50, 95% CI = 0.14 to 1.77).
Conclusions:
The TS design was associated with a higher risk of revision for PPF, but no difference in aseptic revision risk was ultimately observed. If the goal of cementing is to avoid PPF, CB may be preferred to achieve this specific goal. However, both implant types show similar overall long-term revision rates.
Level Of Evidence:
Level III.
