Substantially higher prevalence of postoperative peri­prosthetic fractures in octogenarians with hip fractures operated with a cemented, polished tapered stem rather than an anatomic stem

Abstract

Background and purposeRecent studies have demonstrated a high incidence of postoperative periprosthetic femoral fracture (PPF) in elderly patients treated with 2 commonly used cemented, polished tapered stems. We compared the prevalence and incidence rate of PPF in a consecutive cohort of octagenerians with femoral neck fractures (FNFs) treated with either a collarless, polished tapered (CPT) stem or an anatomic matte stem (Lubinus SP2).Patients and methodsIn a multicenter, prospective cohort study, we included 979 hips in patients aged 80 years and above (72% females, median age 86 (80–102) years) with a femoral neck fracture as indication for surgery. 69% of the patients were classified as ASA class 3 or 4. Hip-related complications and repeat surgery were assessed at a median follow-up of 20 (0–24) months postoperatively.Results22 hips (2.2%) sustained a PPF at a median of 7 (0–22) months postoperatively; 14 (64%) were Vancouver B2 fractures. 7 of the 22 surgically treated fractures required revision surgery, mainly due to deep infection. The cumulative incidence of PPFs was 3.8% in the CPT group, as compared with 0.2% in the SP2 group (p < 0.001). The risk ratio (RR) was 16 (95% CI: 2–120) using the SP2 group as denominator.InterpretationThe CPT stem was associated with a higher risk of PPF than the SP2 stem. We suggest that the tapered CPT stem should not be used for the treatment of femoral neck fractures in patients over 80 years.

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

“…In concordance with our findings, a number of recent studies has also shown association between cemented, polished, tapered stems and a high risk for PPF [10,[14][15][16]. A Scandinavian registry-based study found that the cemented Exeter stem was associated with a fivefold increased risk for PPF compared to the SP2 stem [23].…”

“…Osteopenia, hip fracture as an indication for primary surgery, age greater than 80 years and the use of polished tapered femoral stems have all been associated with an increased incidence of PPF and a predisposition for Vancouver B2 PPFs [10,[20][21][22]. In a previous study from our institution, we found that the polished, tapered CPT stem was associated with a high incidence of early PPF in an FNF population more than 80 years of age [15]. In the present study, we investigated the more commonly used Exeter stem in comparison to the anatomic Lubinus SP2 stem.…”

“…The two most commonly used cemented implants in Sweden for treating a displaced FNF are the polished, tapered Exeter stem and the matte, anatomic Lubinus SP2 stem [13]. Recent reports have identified a high incidence of PPF associated with the Exeter and the similarly tapered (CPT, Zimmer, Inc., Warsaw, IN, USA) stems in elderly FNF patients [10,[14][15][16]. There are few cohort studies comparing the Exeter and Lubinus femoral stems regarding the risk for PPF in patients with hip fractures.…”

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

“…Other studies have reported the incidence of PPF to be 0-4%. Clinical observational studies (117,196,197) have a tendency to report higher incidence of rare complications than register studies (85,118,198 Even though our paper focused on the rare PPFs, the most common reason for reoperation was infection followed by luxation. We have no good explanation as to why polished TS stems had a higher incidence of infection.…”

“…6) (116). 24 Small observational studies including both HAs and THAs (117)(118)(119) and one large register study on THAs (120) Patients treated with HA for FNF represent an older and more comorbid population with more osteoporotic bone structure than THA patients (10), and the risk of PPF could therefore potentially be higher than for THA patients.…”