More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures: a study from the Norwegian Hip Fracture Register 2005 to 2016

• Published in: The bone & joint journal Vol. 100-B; no. 12; pp. 1565 - 1571
• Main Authors: Kristensen, T B, Dybvik, E, Furnes, O, Engesæter, L B, Gjertsen, J-E
• Format: Journal Article
• Language: English
• Published: England 01.12.2018
• Subjects: Aged; Aged, 80 and over; Bone Cements; Female; Follow-Up Studies; Hemiarthroplasty - adverse effects; Hip Fractures - diagnosis; Hip Fractures - surgery; Hip Prosthesis; Humans; Incidence; Male; Norway - epidemiology; Periprosthetic Fractures - epidemiology; Periprosthetic Fractures - etiology; Periprosthetic Fractures - surgery; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Prospective Studies; Prosthesis Design; Registries; Reoperation - statistics & numerical data; Risk Factors; Treatment Outcome; Reoperation; Periprosthetic fracture; Hemiarthroplasty
• ISSN: 2049-4394; 2049-4408
• DOI: 10.1302/0301-620X.100B12.BJJ-2018-0262.R1

The aim of this large registry-based study was to compare mid-term survival rates of cemented femoral stems of different designs used in hemiarthroplasty for a fracture of the femoral neck. From the Norwegian Hip Fracture Register (NHFR), 20 532 primary cemented bipolar hemiarthroplasties, which were undertaken in patients aged > 70 years with a femoral neck fracture between 2005 and 2016, were included. Polished tapered stems (n = 12 065) (Exeter and CPT), straight stems (n = 5545) (Charnley, Charnley Modular, and Spectron EF), and anatomical stems (n = 2922) (Lubinus SP2) were included. The survival of the implant with any reoperation as the endpoint was calculated using the Kaplan-Meier method and hazard ratios (HRs), and the different indications for reoperation were calculated using Cox regression analysis. The one-year survival was 96.0% (95% confidence interval (CI) 95.6 to 96.4) for the Exeter stem, 97.0% (95% CI 96.4 to 97.6) for the Lubinus SP2 stem, 97.6% (95% CI 97.0 to 98.2) for the Charnley stem, 98.1% (95% CI 97.3 to 98.9) for the Spectron EF stem, and 96.4% (95% CI 95.6 to 97.2) for the Charnley Modular stem, respectively. The hazard ratio for reoperation after one year was lower for Lubinus SP2 (HR 0.77, 95% CI 0.60 to 0.97), Charnley (HR 0.64, 95% CI 0.48 to 0.86), and Spectron EF stems (HR 0.44, 95% CI 0.29 to 0.67) compared with the Exeter stem. Reoperation for periprosthetic fracture occurred almost exclusively after the use of polished tapered stems. We were able to confirm that implant survival after cemented hemiarthroplasty for a hip fracture is high. Differences in rates of reoperation seem to favour anatomical and straight stems compared with polished tapered stems, which had a higher risk of periprosthetic fracture.