Does Stem Design Affect the Incidence of Periprosthetic Femoral Fractures in Arthroplasty for Femoral Neck Fractures? A Secondary Analysis of the HEALTH Trial
Abstract
INTRODUCTION
The aim of this study was to evaluate how stem design influences the risk of periprosthetic femoral fractures (PFFs) after hemiarthroplasty (HA) and total hip arthroplasty (THA) for femoral neck fractures (FNFs).
METHODS
We performed a secondary analysis of the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemi-Arthroplasty (HEALTH) trial, a multicenter, prospective, randomized control trial that assessed THA versus HA for low-energy FNFs. Between 1,374 patients (414 men, 960 women) that were assessed, 72 sustained PFFs (5.2 %). Intraoperative PFFs were recorded in 42 patients, early postoperative PFFs in 15 and late PFFs in 15 patients. The incidence of PFFs was compared between cemented and cementless stems. Within the cemented group (n = 896), we analyzed the effect of taper-slip (n = 482) versus composite-beam (n = 414) designs, while within the cementless group (n = 478), we assessed the impact of single-wedged (n = 206) versus metaphyseal-filling stems (n = 272). The role of collars (n = 87) was also examined within the press-fit stems. Clinical outcomes were recorded with the Western Ontario and McMaster Universities Arthritis Index (WOMAC).
RESULTS
Cemented stems had a significantly lower incidence of PFFs compared to their cementless counterparts (2.6 versus 10.3%, P 0.05). Most of the composite-beam PFFs occurred intraoperatively (75 %), while most of the taper-slip PFFs occured late (55%). There was no difference between…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,374 participants or records.
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