JOA - 2026-05-13 - Journal Article
Incidence of Early Periprosthetic Hip Fractures in Patients Over Age 70 Years Following Primary Total Hip Arthroplasty Using a Novel Triple-Tapered Collared Femoral Stem.
Smith NS, Grimm AJ, Malkani AL, Gililland JM, Mayman DJ, Westrich GH, Zepeda KE, Smith LS, Jerabek SA
Topics
Key Takeaway
A triple-tapered collared femoral stem reduced early periprosthetic fracture incidence from 1.8% to 0.26% (p=0.038) in patients over 70 undergoing primary THA compared to a dual-tapered collarless stem.
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Summary
This multicenter retrospective study compared early periprosthetic fracture incidence between a novel triple-tapered collared stem and a dual-tapered collarless stem in patients over 70 undergoing primary THA. Early periprosthetic fractures occurred in 1.8% of the dual-tapered group versus 0.26% in the triple-tapered group (p=0.038). Overall revision rates were also significantly lower in the triple-tapered group (1.0% vs. 5.7%, p<0.01), though the dual-tapered group had longer follow-up, higher BMI (29.9 vs. 28.4), and higher mean age (76.0 vs. 75.2).
Key Limitation
Unequal and uncontrolled follow-up duration between groups introduces ascertainment bias, making the revision rate comparison unreliable and potentially overstating the benefit of the triple-tapered stem.
Original Abstract
INTRODUCTION
Periprosthetic hip fractures are a known complication following cementless total hip arthroplasty (THA), especially in elderly patients. A triple-tapered collared femoral stem was introduced to provide multidirectional contact, resist torsional forces, and distribute load to help reduce subsidence. The purpose of this study was to determine the incidence of periprosthetic femoral fractures with a novel triple-tapered collared femoral stem in a group of patients who were aged greater than 70 years undergoing primary THA.
METHODS
This was a multi-center retrospective analysis of patients who were aged greater than 70 years undergoing primary THA. There were 385 THAs that had a triple-tapered collared stem compared to 383 dual-tapered collarless stems. There were no differences between groups regarding sex and American Society of Anesthesiologists (ASA) class. The dual-tapered group had a higher average body mass index (BMI) than the triple-tapered group (29.9 versus 28.4, P < 0.01) and higher age (76.0 versus 75.2, P = 0.022). Overall revision rates, incidence of periprosthetic fractures, and complications were compared.
RESULTS
There were seven (1.8%) early (less than one month) periprosthetic fractures in the dual-tapered group, and one (0.26%) early fracture in the triple-tapered group (P = 0.038). The dual-tapered group had a longer follow-up and a higher overall revision rate of 5.7%, primarily due to prosthetic joint infection (PJI) and periprosthetic fractures. There were four revisions in the triple-tapered collared group (1.0%, P < 0.01).
CONCLUSION
The use of a novel triple-tapered collared stem was associated with a significant decrease in the incidence of periprosthetic fractures in patients who were aged greater than 70 years undergoing primary THA. Given the increased mortality of periprosthetic hip fractures in elderly patients, the results of this study appear promising and require additional follow-up to determine if the results are durable.