Collared stems are protective against revision due to early periprosthetic femoral fracture: A cross-sectional study

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-08-18 DOI:10.1016/j.jor.2025.08.024

Danielle DeMoes , Roham Borazjani , Isabella Masso , Anthony Gualtieri , Stefan Kreuzer

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引用次数: 0

Abstract

Aims & objectives

Collared stems have demonstrated acceptable long-term survivorship in cementless total hip arthroplasty (THA). However, their impact on early postoperative periprosthetic femoral fracture (PFF) remains unclear. This study compares early PFF rates requiring revision between collared and collarless stems in cementless THA and identifies risk factors.

Materials & methods

All consecutive patients undergoing primary, navigated, cementless unilateral THAs at our center from 2018 to 2024 were included. Non-navigated, cemented, or revision THAs were excluded. Early PFFs, defined as fractures within 90 days, were classified using the Vancouver system.

Results

Among 2859 patients (mean age 63.79 ± 10.58), 64.4 % received collarless stems. They were significantly younger (60.92 ± 10.49 vs. 68.99 ± 8.57, p < 0.001). Most in the collared group were female (62.7 %), while collarless recipients were mainly male (55.1 %, p < 0.001). Patients with ASA ≥3 were more likely to receive collared stems (72.6 % vs. 37.0 %, p < 0.001). Fifteen PFFs requiring revision were identified, all Vancouver B2, with 86.6 % classified as early PFFs. The fracture rates were comparable in univariate analysis (p = 0.128). Regression analysis showed collared stems significantly reduced PFF risk (OR: 0.081, 95 % CI: 0.01–0.39, p = 0.001). Conversely, increasing age (OR: 1.157 per year, 95 % CI: 1.07–1.27, p < 0.001) was associated with higher risk.

Conclusion

Collared stems significantly reduced PFF risk after adjusting for confounders, while older age independently increased fracture risk. Therefore, careful patient selection is crucial, especially for older patients.

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一项横断面研究表明，由于早期股骨假体周围骨折，有圈假体可防止翻修

目的：在无骨水泥全髋关节置换术（THA）中，有圈假体已被证明具有可接受的长期生存率。然而，它们对术后早期假体周围股骨骨折（PFF）的影响尚不清楚。本研究比较了无骨水泥THA中有环和无环的早期PFF发生率，并确定了危险因素。材料和方法纳入2018年至2024年在我中心连续接受原发性、导航性、无骨水泥单侧tha手术的患者。排除非导航、骨水泥或翻修tha。早期pff，定义为90天内的裂缝，使用Vancouver系统进行分类。结果2859例患者（平均年龄63.79±10.58岁）中，64.4%的患者接受了无项圈移植。他们明显年轻（60.92±10.49比68.99±8.57,p < 0.001）。有领组以女性居多（62.7%），无领组以男性居多（55.1%,p < 0.001）。ASA≥3的患者更有可能接受有领茎（72.6% vs. 37.0%, p < 0.001）。确定了15例需要修订的pff，均为温哥华B2, 86.6%为早期pff。在单因素分析中，骨折率具有可比性（p = 0.128）。回归分析显示，有领茎显著降低PFF风险（OR: 0.081, 95% CI: 0.01-0.39, p = 0.001）。相反，年龄增加（OR: 1.157 /年，95% CI: 1.07-1.27, p < 0.001）与较高的风险相关。结论经混杂因素调整后，有领柄可显著降低PFF风险，而年龄越大则单独增加骨折风险。因此，谨慎的患者选择是至关重要的，特别是对于老年患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.