Aims Periprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) are devastating complications that are associated with functional limitations and increased overall mortality. Although cementless implants have been associated with an increased risk of PFF, the precise contribution of implant geometry and design on the risk of both intra-operative and post-operative PFF remains poorly investigated. A systematic review was performed to aggregate all of the PFF literature with specific attention to the femoral implant used.
Patients and Methods A systematic search strategy of several journal databases and recent proceedings from the American Academy of Orthopaedic Surgeons was performed. Clinical articles were included for analysis if sufficient implant description was provided. All articles were reviewed by two reviewers. A review of fundamental investigations of implant load-to-failure was performed, with the intent of identifying similar conclusions from the clinical and fundamental literature.
Results In total 596 articles were initially identified, with 34 being eligible for analysis. Aggregate analysis of 1691 PFFs in 342 719 primary THAs revealed a significantly higher number of PFFs with cementless femoral implants (p < 0.001). Single-wedge and double-wedge (fit-and-fill) femoral implants were associated with a threefold increase in PFF rates (p < 0.001) compared with anatomical, fully coated and tapered/rounded stems. Within cemented stems, loaded-taper (Exeter) stems were associated with more PFFs than composite-beam (Charnley) stems (p = 0.004). Review of the fundamental literature revealed very few studies comparing cementless component designs.
Conclusion Very few studies within the PFF literature provide detailed implant information. Cementless implants, specifically those of single-wedge and double-wedge, have the highest PFF rates in the literature, with most investigations recommending against their use in older patients with osteoporotic bone. This review illustrates the need for registries and future PFF studies to record implant name and information for future analysis. Furthermore, future biomechanical investigations comparing modern implants are needed to clarify the precise contribution of implant design to PFF risk.
Cite this article: Bone Joint J 2017;99-B(1 Supple A):50–9.
A. V. Carli: Devised study methodology, Retrieved articles, Performed article analysis, Wrote manuscript.
J. J. Negus: Retrieved articles, Assisted with article analysis, Edited manuscript.
F. S. Haddad: Assisted with developing study methodology, Interpreted article analysis, Edited manuscript.
This research/study/project was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.
The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by G. Scott.
This paper is based on a study which was presented at the 32nd annual Winter 2015 Current Concepts in Joint Replacement meeting held in Orlando, Florida, 9th to 12th December.
- Received June 13, 2016.
- Accepted June 27, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery