Quadrangular Taper Cementless Designs Are Associated With Lower Risks of Postoperative Periprosthetic Fracture...

Although cementless stems are increasingly favored in primary total hip arthroplasty (pTHA), the impact of stem designs on postoperative complications, such as periprosthetic femoral fracture (PFF), remains debated. This study compared PFF rates between cemented and cementless pTHA, focusing on cementless stem geometries.

We systematically searched PubMed, Embase, Web of Science, Scopus, Google Scholar, and CENTRAL from inception through March 2025. Eligible studies compared cemented and cementless stems in adults undergoing elective pTHAs, reported PFF incidence, and specified cementless stem design. Using a random-effects model, we calculated pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) for primary (PFF) and secondary outcomes (aseptic loosening, dislocation, periprosthetic joint infection, surgical site infection, and all-cause revision). There were 18 studies (55,942 pTHAs) included. Subgroup analyses were performed by cementless stem designs and age. Metaregression was conducted to investigate heterogeneity across the study.

The pooled PFF rate was 1.3% (95% CI: 0.9 to 2.0) for cementless and 0.9% (95% CI: 0.6 to 1.5) for cemented pTHA (OR = 1.38; 95% CI: 0.95 to 2.02; P = 0.089; I² = 45.4%). Quadrangular stems (type B2) significantly reduced PFF risk (OR = 0.78; 95% CI: 0.64 to 0.96, P = 0.033; I² = 0.0%), whereas anatomic fit-and-fill stems (type C2) increased this risk (OR = 2.86; 95% CI = 2.10 to 3.90, P < 0.001; I² = 0.0%) and all-cause revision risk (OR = 1.16; 95% CI = 1.10 to 1.22, P = 0.001; I² = 0.0%). Cementless stems were associated with lower aseptic loosening (OR = 0.36; 95% CI = 0.23 to 0.56; P < 0.001; I² = 50.0%).

Quadrangular stems were protective against PFF, whereas anatomic designs increased PFF and all-cause revision rates. These findings highlight the need for stem-specific considerations in surgical decision making.