Quadrangular Taper Cementless Designs Are Associated With Lower Risks of Postoperative Periprosthetic Fracture Compared With Cemented Stems and Other Cementless Designs Following Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.
Roham Borazjani, Seyyed Hamidreza Ayatizadeh, Mahta Sattarian et al.
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In 30 seconds
This systematic review and meta-analysis compared postoperative periprosthetic femoral fracture (PFF) and other outcomes after primary total hip arthroplasty using cemented or cementless stems, with analyses by cementless stem design. Across 18 studies and 55,942 procedures, overall PFF rates were 1.3% with cementless and 0.9% with cemented stems; the difference was not statistically significant (OR = 1.38; 95% CI: 0.95 to 2.02; P = 0.089). By design, quadrangular stems were associated with lower PFF risk, while anatomic fit-and-fill stems were associated with higher PFF and all-cause revision risks.
Key findings
- Quadrangular stems (type B2) were associated with lower PFF risk (OR = 0.78; 95% CI: 0.64 to 0.96, P = 0.033).
- Anatomic fit-and-fill stems (type C2) were associated with higher PFF risk (OR = 2.86; 95% CI = 2.10 to 3.90, P < 0.001).
- Anatomic fit-and-fill stems were associated with higher all-cause revision risk (OR = 1.16; 95% CI = 1.10 to 1.22, P = 0.001).
- Cementless stems were associated with lower aseptic loosening than cemented stems (OR = 0.36; 95% CI = 0.23 to 0.56; P < 0.001).
Why it matters
The findings suggest that postoperative fracture risk may differ meaningfully among cementless stem geometries, even though the pooled comparison of cementless and cemented stems did not show a statistically significant difference in PFF. Considering design-specific outcomes may therefore help frame implant selection and risk discussions, while the evidence remains based on pooled comparative studies rather than a single randomized comparison.
What to keep in mind
The meta-analysis pooled comparative studies, and the abstract does not report that the evidence came from randomized trials. Overall PFF estimates showed moderate heterogeneity (I 2 = 45.4%).