Collared cemented femoral stems are associated with lower periprosthetic femoral fracture rates: A systematic review and subgroup meta-analysis.
- 1Clinique du Sport Bordeaux-Mérignac, Groupe Vivalto Mérignac France.
- 2Department of Orthopaedics and Traumatology University of Milan, ASST Lecco Milan Italy.
Abstract
Periprosthetic femoral fracture (PFF) is a severe complication after hip arthroplasty. Cemented femoral stems have been used to reduce this risk, while collars have been associated with lower fracture rates in cementless stems. However, the role of a collar in cemented femoral stems remains unclear. This systematic review and meta-analysis compared postoperative PFF rates between collared and collarless cemented femoral stems. Nine comparative cohorts directly comparing collared and collarless cemented stems were included in the odds ratio (OR) meta-analysis. Eligible single-arm cohorts were additionally included in pooled incidence analyses. Random-effects models were used throughout. Predefined subgroup analyses were performed according to surgical indication and stem surface finish, including a polished-stem subgroup comparing polished collared with polished collarless designs. Collared stems were associated with a lower postoperative PFF rate (OR, 0.28; 95% confidence interval [CI], 0.17-0.49; p < 0.00001; I2 = 71%). Pooled PFF incidence was 0.51% for collared stems and 2.27% for collarless stems. This association was observed in elective arthroplasty cohorts (OR, 0.30; 95% CI, 0.15-0.63) and femoral neck fracture cohorts (OR, 0.28; 95% CI, 0.20-0.38). In the polished-stem subgroup, analysis showed a lower odds of PFF with polished collared stems (OR, 0.17; 95% CI, 0.01-2.86; p = 0.22). Pooled incidence was 0.65% for polished collared stems and 2.34% for polished collarless stems. Collared stems were associated with lower PFF rates. This association was observed in both elective arthroplasty and femoral neck fracture cohorts. Polished collared designs also showed lower PFF rates than polished collarless designs. Substantial heterogeneity and confounding by other stem characteristics limit interpretation. Level III.
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BibTeX
@article{laboudie2026collared,
title = {{Collared cemented femoral stems are associated with lower periprosthetic femoral fracture rates: A systematic review and subgroup meta-analysis.}},
author = {Pierre Laboudie and Mattia Blancatto},
journal = {Journal of experimental orthopaedics},
year = {2026},
month = oct,
doi = {10.1002/jeo2.70969},
url = {https://europepmc.org/article/MED/42953399},
note = {CC BY},
}
RIS
TY - JOUR
TI - Collared cemented femoral stems are associated with lower periprosthetic femoral fracture rates: A systematic review and subgroup meta-analysis.
AU - Pierre Laboudie
AU - Mattia Blancatto
PY - 2026
DA - 2026/10/28
JO - Journal of experimental orthopaedics
DO - 10.1002/jeo2.70969
UR - https://europepmc.org/article/MED/42953399
AB - Periprosthetic femoral fracture (PFF) is a severe complication after hip arthroplasty. Cemented femoral stems have been used to reduce this risk, while collars have been associated with lower fracture rates in cementless stems. However, the role of a collar in cemented femoral stems remains unclear. This systematic review and meta-analysis compared postoperative PFF rates between collared and collarless cemented femoral stems. Nine comparative cohorts directly comparing collared and collarless cemented stems were included in the odds ratio (OR) meta-analysis. Eligible single-arm cohorts were additionally included in pooled incidence analyses. Random-effects models were used throughout. Predefined subgroup analyses were performed according to surgical indication and stem surface finish, including a polished-stem subgroup comparing polished collared with polished collarless designs. Collared stems were associated with a lower postoperative PFF rate (OR, 0.28; 95% confidence interval [CI], 0.17-0.49; p < 0.00001; I2 = 71%). Pooled PFF incidence was 0.51% for collared stems and 2.27% for collarless stems. This association was observed in elective arthroplasty cohorts (OR, 0.30; 95% CI, 0.15-0.63) and femoral neck fracture cohorts (OR, 0.28; 95% CI, 0.20-0.38). In the polished-stem subgroup, analysis showed a lower odds of PFF with polished collared stems (OR, 0.17; 95% CI, 0.01-2.86; p = 0.22). Pooled incidence was 0.65% for polished collared stems and 2.34% for polished collarless stems. Collared stems were associated with lower PFF rates. This association was observed in both elective arthroplasty and femoral neck fracture cohorts. Polished collared designs also showed lower PFF rates than polished collarless designs. Substantial heterogeneity and confounding by other stem characteristics limit interpretation. Level III.
SN - 2197-1153
ER -