Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem

Mellner, Carl; Mohammed, Jabbar; Larsson, Magnus; Esberg, Sandra; Szymański, M.; Hellström, Nils; Chang, Cecilia; Berg, Hans E.; Sköldenberg, Olof; Knutsson, Björn; Morberg, Per; Mukka, Sebastian

doi:10.1007/s00068-019-01263-6

Cited by 17 publications

(12 citation statements)

References 36 publications

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“…Other different studies assessing the revision rates of the CPT implants reported a higher rate of periprosthetic fractures in CPT implants when compared to AS implants. 5,[17][18][19][20] The subsidence mechanism of the CPT implants induces hoop stresses to the cement mantle into the host bone which can act as a wedge, fracturing the femur during a fall. 5,21 Also, in the national register-based study of Kristensen et al, 18 with 20,532 primary cemented bipolar hemiarthroplasties, more periprosthetic fractures were observed in CPT implants.…”

Section: Discussionmentioning

confidence: 99%

Survival rates of anatomically shaped and tapered slip cemented femoral implants: an analysis of 76,281 femoral implants of the Dutch arthroplasty register (LROI)

et al. 2022

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Introduction: In cemented total hip arthroplasty (THA) various shapes and geometries of femoral implants are in use. Collarless, polished, and tapered (CPT) implants, and anatomically shaped (AS) implants are most commonly used. Due to their different design features, this might lead to different survival outcomes. In this register-based study, overall implant survival and short-term complications of CPT and AS cemented implants were evaluated. Methods: Data of the Dutch Arthroplasty Register (LROI) were used. Cemented femoral implants, which could be classified as CPT or AS were included in this study. Implants were excluded when no classification could be made or if implanted <100 times. Survival analyses were performed using Kaplan-Meier survival analysis and multivariable Cox-proportional hazard analysis. Results: 76,281 cemented THAs were included. At a mean of 5.1 years follow-up (SD 3.1, range 0–12 years), the overall survival of the AS implants was higher compared with the CPT implants, with a survival, of 99.2% and 99.0% respectively (log-rank; p < 0.001). Multivariable regression analysis revealed a higher rate for revision because of loosening of the AS implants (HR 2; CI, 1.4–3.1). AS implants had a lower rate for periprosthetic fractures compared with the CPT implants (HR 0.13; CI, 0.07–0.23). Conclusions: Both designs show excellent overall survival rates at short-term follow-up. There is a higher overall survival of AS implants when compared with CPT implants. Revision for implant loosening, however, was statistically significantly higher in AS implants when compared with the CPT implants.

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Section: Discussionmentioning

confidence: 99%

Survival rates of anatomically shaped and tapered slip cemented femoral implants: an analysis of 76,281 femoral implants of the Dutch arthroplasty register (LROI)

et al. 2022

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“…Analysis of the cumulative incidence showed that Vancouver B fractures accounted for 6 of the 11 fractures, with the remaining 5 fractures occurring well distal to the stem. Although various studies have demonstrated an association between collarless, polished tapered stems and Vancouver B periprosthetic fractures 25,28,30 , no association has been made between the type of stem and the occurrence of Vancouver C fractures 31 . The increased incidence of Vancouver C fractures in the present study was likely indicative of the tendency to reserve the use of cemented stems for elderly patients or those with poor bone quality, and less directly attributable to the choice of stem 21 .…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, polished tapered stems, which are designed to subside within their cement mantle, may have similar mechanics to tapered uncemented stems that are more susceptible to fracture in the presence of hip trauma. The subsidence may create an axial load, resulting in a Vancouver B periprosthetic fracture (i.e., a fracture around the stem) 28,29 . In the present study, there were 11 cases of periprosthetic fractures, which was higher than the incidence of periprosthetic fractures reported in other studies of primary THAs with Exeter stems and higher than the 10-year cumulative incidence of postoperative periprosthetic fracture reported in the Mayo registry (1.6%) 12 .…”

Section: Discussionmentioning

confidence: 99%

Midterm Results of Primary Exeter Cemented Stem in a Select Patient Population

Gausden

Abdel

Mabry

et al. 2021

Journal of Bone and Joint Surgery

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Background:Most North American surgeons predominantly use uncemented stems in primary total hip arthroplasties (THAs) and reserve cemented stems for selected older patients and those with poor bone quality. However, data on this “selective use” strategy for cemented stems in the population at risk for periprosthetic fracture and implant loosening are limited. The purpose of this study was to describe implant survivorship, complications, and radiographic results of a specific collarless, polished, tapered cemented stem (Exeter; Stryker) used selectively in a predominantly elderly population undergoing primary THA.Methods:We identified 386 patients who underwent a total of 423 primary THAs with selectively utilized Exeter stems for the treatment of osteoarthritis between 2006 and 2017. In the same time period, 11,010 primary THAs were performed with uncemented stems and 961 with non-Exeter cemented stems. The mean patient age was 77 years, 71% were female, and the mean body mass index was 29 kg/m2. Competing risk analysis accounting for death was utilized to determine cumulative incidences of revision and reoperation. The mean follow-up was 5 years (range, 2 to 12 years).Results:The 10-year cumulative incidence of any femoral component revision in this patient cohort was 4%, with 10 stems revised at the time of the latest follow-up. There were no intraoperative femoral fractures. The indications for revision were postoperative periprosthetic femoral fracture (n = 6), dislocation (n = 3), and infection (n = 1). There were no revisions for femoral loosening. The 10-year cumulative incidence of reoperation was 10%. The 10-year cumulative incidence of Vancouver B periprosthetic femoral fracture was 2%. Radiographically, there were no cases of aseptic loosening or osteolysis. There was a significant improvement in median Harris hip score, from 53 preoperatively to 92 at a mean follow-up of 5 years (p < 0.001).Conclusions:The strategy of selectively utilizing a collarless, polished, tapered cemented stem produced a low (4%) cumulative incidence of stem revision at 10 years postoperatively and resulted in no cases of aseptic loosening. The use of the Exeter stem did not eliminate postoperative femoral fractures in this predominantly elderly, female patient population.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…In a cohort comparison of patients aged older than 60 years with femoral neck fracture, patients with a CB Lubinus SP II stem experienced a five-to 16-fold reduction in PFF risk versus a comparable PTS stem group with either an Exeter (Stryker, USA) or CPT stem (Zimmer Biomet). 30,31 Compared to PTS stems, CB stems are more heterogeneous in design, so generalizations across the CB group are difficult. In particular, registry studies do not distinguish between CB stem subtypes in terms of geometry and cement mantle thickness.…”

Section: Cb Stemsmentioning

confidence: 99%

Cemented femoral stem design and postoperative periprosthetic fracture risk following total hip arthroplasty

Jain,

Lamb,

Pandit

2024

Bone Joint J

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Polished taper-slip (PTS) cemented stems have an excellent clinical track record and are the most common stem type used in primary total hip arthroplasty (THA) in the UK. Due to low rates of aseptic loosening, they have largely replaced more traditional composite beam (CB) cemented stems. However, there is now emerging evidence from multiple joint registries that PTS stems are associated with higher rates of postoperative periprosthetic femoral fracture (PFF) compared to their CB stem counterparts. The risk of both intraoperative and postoperative PFF remains greater with uncemented stems compared to either of these cemented stem subtypes. PFF continues to be a devastating complication following primary THA and is associated with high complication and mortality rates. Recent efforts have focused on identifying implant-related risk factors for PFF in order to guide preventative strategies, and therefore the purpose of this article is to present the current evidence on the effect of cemented femoral stem design on the risk of PFF.Cite this article: Bone Joint J 2024;106-B(1):11–15.

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Increased risk for postoperative periprosthetic fracture in hip fracture patients with the Exeter stem than the anatomic SP2 Lubinus stem

Cited by 17 publications

References 36 publications

Survival rates of anatomically shaped and tapered slip cemented femoral implants: an analysis of 76,281 femoral implants of the Dutch arthroplasty register (LROI)

Survival rates of anatomically shaped and tapered slip cemented femoral implants: an analysis of 76,281 femoral implants of the Dutch arthroplasty register (LROI)

Midterm Results of Primary Exeter Cemented Stem in a Select Patient Population

Cemented femoral stem design and postoperative periprosthetic fracture risk following total hip arthroplasty

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