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Updated: Jul 25, 2026
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Threefold Decrease in Early Periprosthetic Femur Fracture Risk With a Modern, Triple-Tapered, Noncemented, Collared
Colin C Neitzke1, Manoshi Bhowmik-Stoker, Ahmad Faizan
1From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Neitzke, Westrich, and Gausden), the Stryker, Mahwah, NJ (Bhowmik-Stoker and Faizan), the Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT (Gililland), and the Bone and Joint Institute of Tennessee, Franklin, TN (Calendine).
A modern noncemented collared stem showed lower revision rates for total hip arthroplasty compared to collarless designs. This stem also demonstrated reduced periprosthetic femur fracture incidence, similar to cemented stems.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
- Health Services Research
Background:
- Periprosthetic femur fractures (PFFs) are a significant complication after total hip arthroplasty (THA), often necessitating revision surgery.
- While noncemented, collared stems may reduce PFFs, data from large registries are limited.
- Investigating modern stem designs in real-world settings is crucial for improving THA outcomes.
Purpose of the Study:
- To evaluate the incidence of PFFs and early device survivorship for a contemporary noncemented, collared stem.
- To compare outcomes of this stem against other noncemented collarless and cemented stems using registry data.
- To assess the 2-year revision and PFF rates in a large patient cohort.
Main Methods:
- Analysis of primary THA cases (age >65) from the American Joint Replacement Registry (AJRR) between 2021-2024.
- Stratification into three cohorts: noncemented collared stem, noncemented collarless stems, and cemented stems.
- Linking AJRR data with Medicare claims for 2-year revision and PFF incidence determination.
Main Results:
- The noncemented collared stem exhibited the lowest 2-year all-cause revision rate (1.32%) compared to cemented (2.02%) and collarless (2.22%) stems (P < 0.001).
- 2-year PFF incidence was similar between noncemented collared (0.19%) and cemented (0.20%) cohorts (P = 0.99).
- The noncemented collared stem showed a significantly lower 2-year PFF incidence (0.19%) versus the noncemented collarless cohort (0.65%) (P < 0.001).
Conclusions:
- Modern noncemented, collared stems are associated with significantly lower 2-year all-cause revision rates compared to noncemented, collarless stems.
- The PFF incidence with this modern collared stem was threefold lower than collarless designs and comparable to cemented stems.
- This study supports the use of modern noncemented, collared stems for potentially reducing revision rates and PFFs in THA.
