Leave the Stem! Survivorship and Infection Management With One Triple-Tapered Collared Stem in the First Decade of Use

Abstract Background The triple-tapered collared cementless stem has been the predominant femoral stem used at our institution for total hip arthroplasty (THA) in the last decade. Because of the difficulty of removing this stem when well-fixed, we have managed a vast majority of periprosthetic joint infections (PJI) with stem retention. The purpose of this study is to report stem survivorship, with a focus on the management of infection. Methods A single institutional database query from 2016–2025 identified 6149 primary THAs using one triple tapered femoral stem (Actis, Depuy Synthes, Warsaw, IN). The mean age at surgery was 66.3±10.5 years and 58.4% of THAs were women. A database query and chart review was performed to identify all reoperations, revisions, and periprosthetic joint infections (PJI). A Kaplan-Meier survivorship was calculated. Results The Kaplan-Meier survivorship at 2 years and 5 years was 99.8% (95%CI 99.7–99.9). A total of 12 (0.20%) femoral stems were removed, 8 (0.13%) for periprosthetic fracture, 3 (0.05%) for infection and 1 to aid in exposure of an early acetabulum fracture. The overall rate of deep PJI of the cohort was 0.26% (16/6149). Of these cases, 2 were treated with 2-stage exchange, 1 was treated with single-stage exchange, 1 was treated with single-stage exchange with stem retention, and 12 were treated with debridement, antibiotics and implant retention (DAIR). Only one of the three stem removals was a late infection with a well-fixed stem, the other 2 were early infections with straightforward stem removal. To our knowledge, none of the femoral stems treated with DAIR have required stem removal. 14 (0.23%) cases were given long-term suppressive antibiotics. Conclusions Over a decade of use, cementless THA with this triple tapered femoral stem yields excellent survivorship. We removed one well fixed stem for infection over this decade, successfully managing other infections with stem retention.