Periprosthetic Femoral Fractures and Reoperation With the Exeter V40 Stem in Total Hip Arthroplasty (Tha) Using National Data Linkage: A 22-Year Review of 17,194 Cases From a National Treatment Centre

Polished taper slip (PTS) stems remain the most widely used design in total hip arthroplasty (THA) in the UK, though concerns persist regarding their association with periprosthetic femoral fractures (PFF). This study aimed to establish the incidence of intraoperative PFF (IOPFF) and postoperative PFF (POPFF) with the Exeter V-40 cemented stem. This retrospective cohort study of consecutive patients undergoing primary THA with Exeter V-40 stem at a single centre (2003–2024). Demographics, ASA grade, and reoperation data were collected. National data linkage using ICD-10 and OPCS-4 codes identified potential IOPFF, POPFF, and all-cause reoperations. Electronic health records (EHR) were reviewed for true fracture incidence. Cox regression identified independent predictors of reoperation for POPFF. 17,194 Exeter THRs were identified (61% female, median age 70 years. Full EHR review was undertaken for 1,841 patients (10.7%); 951 patients with coding suggestive of PFF, and failure in data-linkage for 887 patients. Twenty IOPFFs (0.1%) were identified, 65% involving the trochanter. 357 patients (2.1%) underwent reoperation (person-time incidence rate [PTIR] 2.83 per 1,000 person-years, 95% CI 2.6–3.1), including 73 reoperations for POPFF (PTIR 0.58 per 1,000 person-years). Older age independently predicted all-cause reoperation (adjusted HR 1.03). There was an independent association for reoperation for POPFF, when adjusting for age and sex, with higher offset (50mm+) Exeter stems (aHR 1.78) compared to 44mm. Exeter V-40 stems demonstrates excellent long-term performance with low rates of IOPFF, POPFF, and reoperation when accurate coding is performed. This raises questions regarding the accuracy of some registry-derived estimation of PFF incidence and further work is required into validation of PFF coding.