Do Polished, Tapered, Cemented Stems Implanted to Treat Neck of Femur Fracture Increase the Risk of Subsequent Periprosthetic Femur Fracture Compared to Matte Anatomical Stems? A Systematic Review

Incidence of hip fracture is increasing alongside ageing populations and with that come the inevitable complication. One such complication, periprosthetic fracture, is a costly condition to manage with high associated morbidity and mortality. There are many different risk factors associated with periprosthetic fractures and recent studies have suggested that the use of a polished tapered stem for treatment of neck of femur fractures in the elderly may increase risk when compared to use of a matte anatomical stem.

We performed a systematic review of the literature to assess this risk. Review was performed by computer based search of online search engines by Cochrane Library, Embase, Medline, Web of Knowledge, SCOPUS, Google Scholar, OpenGrey, National Library of Medicine (NLM), OpenDOAR and Bielefeld Base. Inclusion criteria required observational studies reporting on a cohort where either polished tapered or matte anatomical stems were implanted to treat neck of femur fractures and periprosthetic fracture rate for the cohort was reported. We identified eight studies where either polished tapered or matte anatomical femoral stems were implanted to treat neck of femur fractures in elderly populations. The combined cohort comprised 7250 subjects with a mean weighted age of 83.17 years. Only one study was identified which compared the two stem types directly in the appropriate cohort.

We estimated an increased risk for periprosthetic fracture with polished tapered stem (2.3%) when compared to a matte anatomical stem (0.5%) when implanted for treatment of neck of femur fracture (p-value 0.0002). Meta-analysis could not be performed due to the absence of two arm studies. Evidence of increased risk for periprosthetic fracture with the use of polished tapered stems in elderly populations after treatment for neck of femur fracture is inconclusive. Joint and hip fracture registry data may potentially be utilised to fully evaluate this risk compared to matte anatomical stems in order to identify required changes to practice.