Low Rate of Periprosthetic Femoral Fracture in Dorr Type B and C Femurs With the Anterior Approach Using Stems Cemented According to the “French Paradox”

Background Periprosthetic femoral fracture (PFF) is a raising concern following hip arthroplasty in Dorr type B and C femurs. Cemented Charnley-Kerboull (CK) stems implanted according to the "French paradox" through the Hueter anterior approach may represent a reliable option in this at-risk population, but the rate of early PFF in this specific setting remains unclear. Methods From a prospectively collected database, all hemiarthroplasties using CK stems (AmisK, Medacta) implanted consecutively from 2017 to 2023 through the Hueter anterior approach in patients with Dorr type B and C femur were included. Results A total of 670 CK stems were included. The mean follow-up was 31.2 ± 1.1 months (1–36). The mean age was 85.5 ± 8.0 years, and the mean body mass index was 22.1 ± 4.4 kg/m 2 . According to the Dorr classification, 357 (53.3%) hips were of Dorr type B, and 313 (46.7%) of Dorr type C. Among the 670 hemiarthroplasties, a total of 10 (1.49%; 95% confidence interval [CI], 0.57–2.41%) early PFFs were observed, including 5 in Dorr type B femurs (1.40%; 95% CI, 0.18–2.62%), and 5 in Dorr type C femurs (1.60%; 95% CI, 0.21–2.99%). No cases of severe bone cement implantation syndrome were reported. Conclusions This study demonstrated that CK stems cemented according to the "French paradox" were associated with a low rate of early PFF (1.49%) in this extremely high-risk patient population. No cases of severe bone cement implantation syndrome were reported.