Risk of fracture after primary total hip arthroplasty using a collared cementless stem or a polished taper-slip cemented stem

Aims
We set out to determine, when using either the collared Corail cementless stem or the Exeter polished taper-slip cemented stem, the incidence of intraoperative periprosthetic femoral fracture (IOPFF), postoperative periprosthetic femoral fracture (POPFF), and femoral prosthetic fracture.

Methods
This was a retrospective review of a consecutive series of 11,018 total hip arthroplasties (THAs) over a ten-year period (January 2010 to February 2020). Fractures were identified using an exhaustive review of regional radiograph archiving and electronic care systems.

Results
Of the total stems, 4,952 were Corail and 6,066 Exeter designs. There were no differences in age, sex, and BMI between groups. There was a greater incidence of IOPFF with the Corail (42 Corail vs 11 Exeter; p < 0.001). Three patients in each group had a femoral shaft fracture; the remaining fractures were either the calcar (20 Corail and two Exeter) or the greater trochanter (11 Corail and six Exeter). Overall, there was no difference in the rate of POPFF (p = 0.345). However, POPFF in males was greater with the Exeter (p < 0.001), and significantly more Exeter POPFFs required a reoperation (p < 0.001). There were five (0.08%) Exeter stem fractures and none with the Corail implant.

Conclusion
There were significantly more IOPFFs with Corail, which occurred in the calcar or greater trochanter, but these had no impact on early recovery or one-year Oxford Hip Scores. Males with the Exeter stem had a five-times greater risk of having a reoperation for POPFF. Females had the same risk of reoperation for fracture with either component. Femoral prosthetic fractures only occurred with the Exeter stem. These results represent robust estimates, which are likely to be more accurate than revision-only studies typically generated from registry data.