- Design
- National registry cohort, Norway, Cox regression
- Population
- 204,041 primary hip arthroplasties, 2005 to 2025
- Primary outcome
- Reoperation for periprosthetic femoral fracture
- Effect
- Men: polished taper-slip and uncemented collarless about 9 times the risk of composite beam stems
A Norwegian analysis of 204,041 primary hip arthroplasties from 2005 to 2025, drawn from the national arthroplasty and hip fracture registers, compared four femoral stem types: cemented composite beam, cemented polished taper-slip, uncemented collarless and uncemented collared. The outcome was reoperation for periprosthetic femoral fracture.
In men, polished taper-slip and uncemented collarless stems carried about nine times the risk of composite beam stems, and collared uncemented stems about four times. The risk with polished taper-slip stems was raised in men of all ages; for uncemented collarless stems it rose in men over 65, and for collared uncemented stems in men over 75. In women, risk was higher with uncemented collarless stems from age 60, and with polished taper-slip and collared stems from age 70.
The authors conclude that composite beam stems should be preferred at least for men over 75 and women over 70, and that where an uncemented stem is chosen, a collared one performed best.
Registry data cannot fully adjust for why a surgeon chose a given stem, and implant availability differs between countries, including in India. But the size and consistency of the gap make it worth reviewing stem choice for older patients.
- For men over 75 and women over 70, consider a cemented composite beam stem.
- If using an uncemented stem in an older patient, consider a collared design.
- Be cautious with polished taper-slip stems in men of any age, given the fracture signal.
- Record stem type and fixation clearly; it shapes future fracture risk.
- Check what your local implant registry shows for the stems you use.
Why it matters
One stem design does not suit every patient; sex and age change the trade-off.
Don't overread it
This is registry data; it shows associations with stem type, not a randomised comparison.
The statistics, in plain English
A nine-fold higher hazard is large in relative terms, but periprosthetic fracture needing reoperation is uncommon, so the absolute difference per hundred hips is much smaller. The abstract does not give absolute rates.
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