JOA - 2026-05-22 - Journal Article
Cemented Femoral Stem Design Is Not Associated with Differences in All-Cause Revision or Specific Failure Modes after Total Hip Arthroplasty for Femoral Neck Fracture.
Gusho CA, Hoskins W, Riley C, Kelly M, Hegde V, Kagan R, Ghanem ES
Topics
Key Takeaway
Among 3,479 patients ≥65 undergoing cemented THA for femoral neck fracture, taper-slip and composite beam stems showed no statistically significant difference in all-cause revision (1.8% vs. 3.2%; HR 1.81, 95% CI 0.96–3.40, P=0.06).
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Summary
This study asked whether taper-slip versus composite beam cemented femoral stem design affects revision rates in patients ≥65 undergoing THA for femoral neck fracture, using AJRR data from 2012–2021. Cox proportional hazard models with competing risks of death found no statistically significant differences in all-cause revision, 90-day revision, or revision for any specific failure mode including dislocation (HR 5.58, 95% CI 0.76–41.0), fracture, aseptic loosening, or infection. Clinically notable trends toward higher early revision and dislocation with taper-slip stems were underpowered to reach significance given the 17.2% taper-slip representation in the cohort.
Key Limitation
Taper-slip stems represented only 17.2% of the cohort, leaving the study critically underpowered for low-frequency outcomes such as dislocation revision, where the wide confidence interval (HR 5.58, 95% CI 0.76–41.0) precludes meaningful clinical conclusions.
Original Abstract
BACKGROUND
Cemented stem fixation in total hip arthroplasty (THA) for femoral neck fracture (FNF) has increased in utilization. Cemented stems reduce the periprosthetic fracture risk compared to cementless fixation, but it is unclear whether revision varies by stem design in this cohort. We compared taper-slip versus composite beam cemented stems among FNF patients undergoing THA using a modern classification system.
METHODS
Patients ≥ 65 years of age undergoing primary THA for FNF between 2012 and 2021 with a minimum two-year follow-up were screened within the American Joint Replacement Registry. A total of 3,479 cases (mean (standard deviation) follow-up: 78.8 months (28.3)) met inclusion. The primary analysis compared all-cause and 90-day revision between taper-slip (n = 599; 17.2%) and composite beam (n = 2,880; 82.3%) stems. The secondary analyses compared revision for aseptic loosening, fracture, infection, dislocation, and mortality. Cox proportional regressions with competing risks of death evaluated the association of revision with stem design when adjusted for confounders.
RESULTS
Taper-slip stems had an all-cause revision rate of 1.8% (n = 11 of 599) versus composite beams (3.2% (n = 92 of 2,880); P = 0.07). There were no statistically significant differences observed in all-cause revision (hazard ratio (HR) 1.81; 95% confidence interval (CI) 0.96 to 3.40; P = 0.06), 90-day all-cause revision (HR 3.48; 95% CI 0.82 to 14.67; P = 0.09), revision for fracture (HR 0.90; 95% CI 0.29 to 2.73; P = 0.86), aseptic loosening (HR 1.77; 95% CI 0.39 to 8.04; P = 0.46), infection (HR 1.40; 95% CI 0.41 to 4.79; P = 0.59), or dislocation (HR 5.58; 95% CI 0.76 to 41.0; P = 0.09) compared to composite beam stems after adjustment.
CONCLUSIONS
There were no statistically significant differences in revision observed between taper-slip and composite beam cemented femoral stems for patients undergoing THA for FNF. Clinically relevant trends (e.g., in early revision and dislocation) warrant further study with larger cohorts and longer follow-up.