Periprosthetic Fracture Rate in Elderly Patients Undergoing Hip Hemiarthroplasty: A Comparison of Fit-and-Fill, Tapered-Wedge, and Cemented Stems.

Abstract

Objectives: To compare the periprosthetic fracture rates of three stem designs: cemented, press-fit fit-and-fill, and tapered wedge for hemiarthroplasty in geriatric patients with femoral neck fractures.

Methods: Design: Retrospective review.

Setting: Two institutions, including one level I trauma center.

Patient selection criteria: Patients aged 70 years or older with a displaced femoral neck fracture (OTA/AO 31B) treated with press-fit or cemented hemiarthroplasty were included. Patients treated with total hip arthroplasty, conversion procedures, concomitant acetabular fracture, and pathologic fractures were excluded.

Outcome measures and comparisons: Rates of intraoperative and postoperative periprosthetic femur fracture (PFF), 30-day and 1-year mortality, operative time, length of stay, and rate of reoperation were compared between stem subtypes.

Results: A total of 758 consecutive patients (404 tapered wedge, 227 fit-and-fill, and 127 cemented) were included. The mean follow-up was 10.1±14.1, 13.0±16.6, 6.8±10.9 months, for tapered wedge, fit-and-fill, and cemented stems, respectively. Tapered wedge stems had an average age of 83.6 years (range 70-100) with 29.2% male; fit-and-fill stems had an average age of 84.3 years (70-102) with 34.8% male; and cemented stems had an average age of 84.1 years (range 70-100) with 26.0% male. 56 (41 intraoperative and 15 postoperative) PFFs were identified. The rate of PFF between tapered wedge (9.4%), fit-and-fill (4.8%), and cemented stems (5.5%) differed significantly (P = 0.01). Fit-and-fill implants had a lower rate of PFF than tapered wedge implants (P = 0.04) and were equivalent to cemented fixation (P = 0.78). Among intraoperative PFFs, tapered wedge stems had a significantly higher calcar fracture rate than fit-and-fill (P = 0.03) and cemented (P = 0.02) stems. Use of fit-and-fill stems did not result in a higher rate of intraoperative calcar fracture than cemented stems (P = 0.85). Postoperative PFF reoperation rates did not reach statistical significance between fit-and-fill (1.8%), tapered wedge (1.7%), and cemented (0.8%) stems (P = 0.39). Fit-and-fill stems had significantly less operative time than cemented stems (93.6 ± 30.0 vs 108.7 ± 41.0 minutes, respectively; P <0.001). No differences in 30-day (4.5%, 4.9%, 5.5%; P = 0.88) or 1-year mortality (17.1%, 17.0%, 22.4%; P = 0.37) were observed between tapered wedge, fit-and-fill, and cemented stems, respectively.

Conclusions: When treating displaced femoral neck fractures, tapered wedge stems may result in a higher rate of PFF. As an alternative, fit-and-fill stems may lower PFF rates without the risk of bone cement implant syndrome and longer operative times.

Level of evidence: Therapeutic Level III.