Risk of Revision for Periprosthetic Fracture Following Cementless Total Hip Arthroplasty Using a Specific Type 1...

Implant survival following total hip arthroplasty (THA) may differ by femoral stem design. In a series of patients, a consistent pattern of low-energy periprosthetic fracture (PPF) with a specific blade design stem was observed. Therefore, we conducted a cohort study comparing revision risk with a specific stem to other stems.

Adult patients who underwent primary cementless THA for osteoarthritis with a highly crosslinked polyethylene liner and large femoral head (≥ 28 mm) were identified using data from a United states-based health care system's registry (2010 to 2022). There were 9,425 THAs using the specific blade stem compared to 67,484 THAs using other stems. Multivariable Cox regressions were used to evaluate the 90-day revision due to PPF and aseptic revision.

The crude PPF revision incidence was 0.8 and 0.4% for the specific blade stem and other stems, respectively. In adjusted analyses, a higher risk of PPF revision (hazard ratio [HR] = 2.19, 95% confidence interval [CI] = 1.60 to 3.01) and aseptic revision (HR = 1.84, 95% CI = 1.40 to 2.42) with the specific blade stem was observed. This higher risk was observed when comparing the specific blade stem to other type 1 stems (PPF: HR = 2.19, 95% CI = 1.54 to 3.11; aseptic: HR = 1.56, 95% CI = 1.14 to 2.12) as well as to type 2 stems (PPF: HR = 2.12, 95% CI = 1.48 to 3.05; aseptic: HR = 1.90, 95% CI = 1.41 to 2.56), and to type 5 stems (aseptic: HR = 4.71, 95% CI = 2.03 to 10.92).

While revision incidence was low, the specific blade stem was associated with a two-time higher risk of 90-day PPF revision when compared to other stems. These findings may guide surgeons in stem selection where PPF is a concern.

Level III.