Aims Periprosthetic femoral fracture (PPFF) is a serious complication after hip arthroplasty, influenced by femoral component design and fixation. This study examined how sex and age affect the risk of reoperation for PPFF. Methods We analyzed 187,576 primary hip arthroplasties from the Norwegian Arthroplasty Register and Norwegian Hip Fracture Register (2005 to 2023). Femoral components were categorized as: 1) Cemented composite beam (CB), 2) Cemented polished taper-slip (PTS), 3) Uncemented collarless (UCC-), and 4) Uncemented collared (UCC+). Cox regression was used to calculate adjusted hazard rate ratios (aHRR) for PPFF, stratified by sex and age groups. Results In men, PTS (aHRR 6.1 (95% CI 3.8 to 9.8)) and UCC- (6.0 (CI 3.7–9.7)) had considerably higher risk of reoperation for PPFF than CB. For UCC+ the corresponding risk was 3.1 (1.9–5.2). Compared to CB the risk for PPFF was increased in men over 65 years for PTS (7.0 (4.1–11.8)) and UCC- (6.6 (3.9–11.2)), whereas for UCC+ the risk was increased in men over 75 years (5.5 (3.9–11.2)). In women, UCC- had highest risk for PPFF (aHRR 8.4 (6.1 to 11.5)) compared to CB, whereas PTS and UCC+ had similarly increased risk (3.0 (2.2–4.1) and 3.8 (2.7–5.4)). Compared to CB the risk of reoperation for PPFF was increased in women older than 65 years for PTS (3.0 (2.5–12.0)) and UCC+ (3.5 (2.4–5.1)), and in women over 60 with UCC- the risk for PPFF was considerably increased (7.4 (5.4–10.2)). Conclusion CB components had the lowest PPFF reoperation risk across sex and age. UCC+ was the best uncemented option, while UCC- and PTS should be used cautiously in patients over 65 years of age.
Furnes et al. (Thu,) studied this question.