The Effect of Cementless Stem Design on Late Periprosthetic Fractures After Total Hip Arthroplasty. Does the Design of Cementless Stems Affects the Rate of Periprosthetic Femoral Fractures?
- 1Corresponding author. Biopolis (Mezourlo region), Larissa 41110, Greece. Tel.: +3 024 135 02719.
- 2Orthopaedic Department, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
Abstract
Background: Periprosthetic femoral fractures (PFFs) are a leading cause of revision after total hip arthroplasty (THA). Cementless stems have been associated with higher rates of early and late PFFs than cemented fixation. This study evaluated whether cementless stem design is associated with the risk of late PFF following primary THA. Methods: We performed a retrospective review of all primary cementless THAs implanted at a tertiary teaching hospital between January 2000 and December 2023 (n = 3772). Early fractures (<3 months) were excluded. PFFs were classified according to Vancouver classification. Stem designs were analyzed individually and grouped according to the Khanuja classification. Kaplan–Meier survival analysis was performed with PFF as the endpoint, and survival distributions were compared using log-rank tests. Cox regression was used to assess the association of age and sex with PFF risk. Results: At a mean follow-up of 14.5 years, the incidence of late PFF was 1.4% (53 of 3772). No difference in overall survival was observed among stem designs ( P = .108). Exploratory pairwise comparisons showed higher PFF-free survival for 1 type 2 stem design than for two other type 2 designs ( P = .002 and P = .003, respectively). No differences were found between type 2 (double wedge) and type 3 (tapered) stems ( P = .510). Increased age was independently associated with PFF ( P = .02). Conclusions: Late PFF after cementless THA was uncommon. Although survivorship did not differ between broad stem categories, variability among individual designs warrants further evaluation in larger multicenter or registry-based studies.
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BibTeX
@article{antoniosakoutalos2026effect,
title = {{The Effect of Cementless Stem Design on Late Periprosthetic Fractures After Total Hip Arthroplasty. Does the Design of Cementless Stems Affects the Rate of Periprosthetic Femoral Fractures?}},
author = {Antonios A. Koutalos, MD, PhD and Vasileios Akrivos, MD and Nifon Gkekas, MD and Theofilos Karachalios, MD, DSc, PhD},
journal = {Arthroplasty Today},
year = {2026},
month = nov,
doi = {10.1016/j.artd.2026.102178},
url = {https://doi.org/10.1016/j.artd.2026.102178},
note = {CC BY},
}
RIS
TY - JOUR
TI - The Effect of Cementless Stem Design on Late Periprosthetic Fractures After Total Hip Arthroplasty. Does the Design of Cementless Stems Affects the Rate of Periprosthetic Femoral Fractures?
AU - Antonios A. Koutalos, MD, PhD
AU - Vasileios Akrivos, MD
AU - Nifon Gkekas, MD
AU - Theofilos Karachalios, MD, DSc, PhD
PY - 2026
DA - 2026/11/08
JO - Arthroplasty Today
DO - 10.1016/j.artd.2026.102178
UR - https://doi.org/10.1016/j.artd.2026.102178
AB - Background: Periprosthetic femoral fractures (PFFs) are a leading cause of revision after total hip arthroplasty (THA). Cementless stems have been associated with higher rates of early and late PFFs than cemented fixation. This study evaluated whether cementless stem design is associated with the risk of late PFF following primary THA. Methods: We performed a retrospective review of all primary cementless THAs implanted at a tertiary teaching hospital between January 2000 and December 2023 (n = 3772). Early fractures (<3 months) were excluded. PFFs were classified according to Vancouver classification. Stem designs were analyzed individually and grouped according to the Khanuja classification. Kaplan–Meier survival analysis was performed with PFF as the endpoint, and survival distributions were compared using log-rank tests. Cox regression was used to assess the association of age and sex with PFF risk. Results: At a mean follow-up of 14.5 years, the incidence of late PFF was 1.4% (53 of 3772). No difference in overall survival was observed among stem designs ( P = .108). Exploratory pairwise comparisons showed higher PFF-free survival for 1 type 2 stem design than for two other type 2 designs ( P = .002 and P = .003, respectively). No differences were found between type 2 (double wedge) and type 3 (tapered) stems ( P = .510). Increased age was independently associated with PFF ( P = .02). Conclusions: Late PFF after cementless THA was uncommon. Although survivorship did not differ between broad stem categories, variability among individual designs warrants further evaluation in larger multicenter or registry-based studies.
SN - 2352-3441
ER -