Double taper hydroxyapatite-coated implant tied to lower postoperative periprosthetic femur fractures

557 primary THAs in patients aged 70 or over were reviewed for PPFFs from a consecutive series of 2011 patients undergoing direct anterior THA from a fellowship-trained adult reconstruction surgeon. Exclusion criteria included age (<70) and posterior approach.

For the first cohort of 361 patients (79 of which passed exclusion criteria) the surgeon used a single-tapered, proximally porous coated, collarless titanium stem. For the next 1650, (478 of which passed exclusion), the surgeon used a dual-tapered, collared, hydroxyapatite-coated titanium stem.

Included patients were carefully monitored for PPFFs. A Fisher's exact test was used to compare the incidence PPFFs between the 2 implant designs.

The study highlighted that 2 of 79 (2.5%) patients had atraumatic PPFFs at an average of 19.5 days post-operatively in the first cohort. Both experienced a Vancouver type B2 periprosthetic fracture and required femoral revision. However, no patients (0/478, 0%) in the second group sustained a PPFF. (P = 0.0199).

Hence, the authors concluded that "the dual-taper, hydroxyapatite-coated implant had a significantly lower PPFF rate among elderly patients than a single-taper, proximally porous stem without a collar."