TY - JOUR
T1 - Periprosthetic Femoral Fracture Is a Leading Cause of Early Revision With Taper-Slip Stems in Primary Total Hip Arthroplasty
T2 - An Analysis of 2765 Total Hip Arthroplasties From a High-Volume Hospital
AU - Pakarinen, Oskari A.
AU - Neuvonen, Perttu S.
AU - Lainiala, Olli S.
AU - Reito, Aleksi R.P.
AU - Eskelinen, Antti P.
N1 - Funding Information:
Source of Funding: This work was supported by the competitive research funds of Pirkanmaa Hospital District, Tampere, Finland (representing governmental funding), Orion Research Foundation, Finnish Research Foundation for Orthopedics and Traumatology, Paivikki and Sakari Sohlberg Foundation and Vappu Uuspää Foundation. The sources of funding had no role at any stage of this study.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/6/24
Y1 - 2021/6/24
N2 - Background: In 2016, the CPT stem replaced the Exeter stem as the main cemented stem at our institution. We assessed the prevalence of revision for periprosthetic femoral fracture (PFF) in patients operated on with either CPT or Exeter stem and compared the risk for revision between these stems. Methods: Primary total hip arthroplasties either performed in 2012-2015 with Exeter stem (n = 1443) or in 2017-2018 with CPT stem (n = 1322) were included. The prevalence of revision for PFF was compared. The Kaplan-Meier estimated survivorships were calculated for the 2 stem designs. The risk for revision was analyzed using the Cox proportional hazard regression model. Results: At 2 years, PFF was the most common reason for revision in the study population (1.3% prevalence, comprising 35% of all revisions). Moreover, 1.6% (95% confidence interval [CI] 1.0-2.4) of the CPT and 1.0% (95% CI 0.6-1.6) of the Exeter stems had been revised due to PFF. The 3-year Kaplan-Meier probability estimates for all-cause revision were 4.8% for the CPT (95% CI 3.6-6.0) and 3.3% for the Exeter stem (95% CI 2.3-4.3). The hazard ratio for revision due to any reason was 1.1 (95% CI 0.3-3.8) during the first 2 weeks, and 1.8 (95% CI 1.2-2.7, P = .006) from 2 weeks onwards for the CPT compared with the Exeter stem. Conclusion: The considerable number of PFF revisions with taper-slip stems, especially with CPT stems, is a matter of concern. Alternative cemented stems should be considered in patients at high risk for PFF.
AB - Background: In 2016, the CPT stem replaced the Exeter stem as the main cemented stem at our institution. We assessed the prevalence of revision for periprosthetic femoral fracture (PFF) in patients operated on with either CPT or Exeter stem and compared the risk for revision between these stems. Methods: Primary total hip arthroplasties either performed in 2012-2015 with Exeter stem (n = 1443) or in 2017-2018 with CPT stem (n = 1322) were included. The prevalence of revision for PFF was compared. The Kaplan-Meier estimated survivorships were calculated for the 2 stem designs. The risk for revision was analyzed using the Cox proportional hazard regression model. Results: At 2 years, PFF was the most common reason for revision in the study population (1.3% prevalence, comprising 35% of all revisions). Moreover, 1.6% (95% confidence interval [CI] 1.0-2.4) of the CPT and 1.0% (95% CI 0.6-1.6) of the Exeter stems had been revised due to PFF. The 3-year Kaplan-Meier probability estimates for all-cause revision were 4.8% for the CPT (95% CI 3.6-6.0) and 3.3% for the Exeter stem (95% CI 2.3-4.3). The hazard ratio for revision due to any reason was 1.1 (95% CI 0.3-3.8) during the first 2 weeks, and 1.8 (95% CI 1.2-2.7, P = .006) from 2 weeks onwards for the CPT compared with the Exeter stem. Conclusion: The considerable number of PFF revisions with taper-slip stems, especially with CPT stems, is a matter of concern. Alternative cemented stems should be considered in patients at high risk for PFF.
KW - cemented stem
KW - complication
KW - periprosthetic femoral fracture
KW - primary
KW - taper-slip stem
KW - total hip arthroplasty
U2 - 10.1016/j.arth.2021.06.022
DO - 10.1016/j.arth.2021.06.022
M3 - Article
AN - SCOPUS:85111075611
SN - 0883-5403
VL - 36
SP - 3703-3708.e2
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 11
ER -