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Peer-reviewedCC BYArthroplasty today

Femoral Stem Design Influences Early Periprosthetic Fracture Risk Following Total Hip Arthroplasty.

  • Alexandra N Krez1
  • Sean D Toomey2
  • Kyle C Swanson3
  • Carl L Herndon4
  • Jonathan R Danoff1
4 affiliations
  1. 1Department of Orthopaedic Surgery, Northwell Health, North Shore University Hospital, Manhasset, NY, USA.
  2. 2Department of Orthopedic Surgery, PLLC, Swedish Orthopedic Institute, Seattle, WA, USA.
  3. 3The Orthopaedic & Fracture Clinic, Mankato, MN, USA.
  4. 4Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
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Abstract

Periprosthetic femur fracture (PFF) is a significant complication following total hip arthroplasty (THA). Modern collared, triple-taper metaphyseal-filling stems may reduce fracture risk. This study compared a triple-taper metaphyseal stem with other cementless designs to assess early PFF risk, fracture risk by age and bone quality, and the impact of collar position. This retrospective study analyzed 774 primary cementless THAs, including triple-taper metaphyseal (n = 311), single-wedge (n = 294), double-wedge (n = 116), and gradual taper/metadiaphyseal-filling (n = 53) stems. Triple-taper stems were implanted through a prospective multicenter trial, while comparison stems were from a single health system. Patients were stratified by stem design, age, Dorr classification, and collar position. The primary outcome was 90-day PFF. PFF occurred in 53 patients (6.8%), including 15 (1.9%) postoperative fractures requiring reoperation. Patients with PFF were older (P < .001) and predominantly female (P = .02). Triple-taper stems demonstrated lower PFF risk than other designs (odds ratio 0.20; 95% confidence interval, 0.08-0.48; P < .001). PFF rates were 1.9% for triple-taper, 7.8% for single-wedge, 14.7% for double-wedge, and 13.2% for gradual taper stems (all P < .001). Differences persisted across age groups and Dorr A/B femurs. Proud collar positioning increased PFF risk (6.3% vs 0.8%; P = .02). Collared, triple-taper metaphyseal stems were associated with lower early PFF risk across patient ages and bone quality profiles. Seating the collar on the calcar further reduced fracture incidence.

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Cite

BibTeXRIS
BibTeX
@article{krez2026femoral,
  title = {{Femoral Stem Design Influences Early Periprosthetic Fracture Risk Following Total Hip Arthroplasty.}},
  author = {Alexandra N Krez and Sean D Toomey and Kyle C Swanson and Carl L Herndon and Jonathan R Danoff},
  journal = {Arthroplasty today},
  year = {2026},
  month = oct,
  doi = {10.1016/j.artd.2026.102193},
  url = {https://europepmc.org/article/MED/42999679},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Femoral Stem Design Influences Early Periprosthetic Fracture Risk Following Total Hip Arthroplasty.
AU  - Alexandra N Krez
AU  - Sean D Toomey
AU  - Kyle C Swanson
AU  - Carl L Herndon
AU  - Jonathan R Danoff
PY  - 2026
DA  - 2026/10/31
JO  - Arthroplasty today
DO  - 10.1016/j.artd.2026.102193
UR  - https://europepmc.org/article/MED/42999679
AB  - Periprosthetic femur fracture (PFF) is a significant complication following total hip arthroplasty (THA). Modern collared, triple-taper metaphyseal-filling stems may reduce fracture risk. This study compared a triple-taper metaphyseal stem with other cementless designs to assess early PFF risk, fracture risk by age and bone quality, and the impact of collar position. This retrospective study analyzed 774 primary cementless THAs, including triple-taper metaphyseal (n = 311), single-wedge (n = 294), double-wedge (n = 116), and gradual taper/metadiaphyseal-filling (n = 53) stems. Triple-taper stems were implanted through a prospective multicenter trial, while comparison stems were from a single health system. Patients were stratified by stem design, age, Dorr classification, and collar position. The primary outcome was 90-day PFF. PFF occurred in 53 patients (6.8%), including 15 (1.9%) postoperative fractures requiring reoperation. Patients with PFF were older (P < .001) and predominantly female (P = .02). Triple-taper stems demonstrated lower PFF risk than other designs (odds ratio 0.20; 95% confidence interval, 0.08-0.48; P < .001). PFF rates were 1.9% for triple-taper, 7.8% for single-wedge, 14.7% for double-wedge, and 13.2% for gradual taper stems (all P < .001). Differences persisted across age groups and Dorr A/B femurs. Proud collar positioning increased PFF risk (6.3% vs 0.8%; P = .02). Collared, triple-taper metaphyseal stems were associated with lower early PFF risk across patient ages and bone quality profiles. Seating the collar on the calcar further reduced fracture incidence.
SN  - 2352-3441
ER  -