The influence of cemented femoral stem choice on the incidence of revisions for periprosthetic fracture after primary total hip replacement: an analysis of national joint registry data

Journal article

Periprosthetic fracture (PF) after primary total hip replacement (THR) is an uncommon but potentially devastating complication. We analysed data on 257,202 primary THRs with cemented stems and 390 linked first revisions for PF recorded in the National Joint Registry (NJR) of England and Wales to determine if cemented femoral stem brand was associated with the risk of having revision for a PF after primary THR. All cemented femoral stem brands with more than 10,000 primary operations recorded in the NJR were identified. The four most commonly used cemented femoral stems were: Exeter V40 (n=146,409), CPT (n=24,300), C-Stem (n=15,113) and Charnley (n=20,182).

We compared the revision risk ratios due to PF amongst the stems using a Poisson regression model adjusting for patient factors. Compared to the Exeter V40, the age, gender and ASA grade adjusted revision rate ratio for the cemented CPT stem was 3.89 (95%CI 3.07,4.93), for the C-Stem 0.89 (95%CI 0.57,1.41) and for the Charnley stem 0.41 (95%CI 0.24,0.70). Limitations of the study include incomplete data capture, analysis of only PF requiring revision and that observation does not imply causality. Nevertheless, this study demonstrates that the choice of a cemented stem is associated with the risk of revision for PF.

Authors: Palan, J; Smith, M; Gregg, P; Mellon, S; Kulkarni, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: British Editorial Society of Bone and Joint Surgery
• Journal: Bone and Joint Journal
• Volume: 98-B
• Issue: 10
• Pages: 1347-1354
• Publication date: 2016-09-30
• Acceptance date: 2016-05-09
• DOI: 10.1302/0301-620X.98B10.36534
• EISSN: 2049-4408
• ISSN: 2049-4394