Association between cemented femoral stem design and unfavorable postoperative outcomes in hip fracture patients: A systematic review and meta-analysis

Hip arthroplasty is a common operation for fragility hip fractures in the elderly. However, the choice of implant, particularly between collared composite beam (CCB) and collarless polished taper-slip (CPTS) femoral stems, may impact postoperative outcomes. In this study, we aimed to systematically review and compare unfavorable postoperative outcomes associated with these 2 stem designs. We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies indexed in the Medline, Embase, Scopus, and Web of Science databases from their inception dates through December 2023 were included if they reported outcomes comparing collar and collarless femoral stems. Data were extracted and analyzed using a random-effects model for postoperative periprosthetic femoral fractures (PFFs) and reoperations, with results presented as pooled risk ratios (RRs) and 95% confidence intervals (CIs). Four studies involving 24,623 patients with hip fractures were included (CCB: 10,377; CPTS: 14,246). Most patients were female (69%-75%), with a follow-up period of 1 to 3.9 years. The incidence of PFFs was significantly higher in the CPTS group (0.72%) compared to the CCB group (0.14%), corresponding to a pooled RR of 5.34 (95% CI: 2.61-10.92). The overall reoperation rates were 4.40% in the CPTS group and 3.30% in the CCB group, with a pooled RR of 1.26 (95% CI: 1.00-1.59), indicating a marginally significant increase in reoperation risk associated with CPTS stems. While CPTS femoral stems had a higher risk of PFFs in patients with hip fracture, overall reoperation rates were comparable to those experienced with CCB designs. The observed heterogeneity suggests that further high-quality studies with standardized protocols are warranted to reduce variability and refine treatment strategies for hip arthroplasty.