Intraoperative femoral fracture during uncemented total hip arthroplasty: does the stem length matter?

Background: Short stems have been developed to conserve bone stock, especially in the younger population undergoing total hip arthroplasty (THA). They demonstrated functional outcomes comparable to conventional stems. The purpose of this study was to compare the incidence of acute periprosthetic femoral fractures (PPFx) during posterior and lateral THA, between stems of the same manufacturer (Taperloc Microplasty (stem A) versus Taperloc complete (stem B)). Methods: Institution’s database was searched for all primary THA performed between August 2016 and August 2023. Preoperative x-rays were analysed to characterize the proximal femoral geometry, specifically the canal bone ratio (CBR) and canal flare index (CFI). Data analysis was performed to identify risk factors for PPFx. Results: 2107 femoral stems (stem A: 1727, stem B: 380) were implanted. 53% were women. The average age was 70 ± 11 years. PPFx rate was 0.94%, with 20 PPF (stem A: 17, stem B: 3). There was no significant difference in PPFx rates between the 2 stems (0.98% vs. 0.79%, p > 0.72) The multivariate regression analysis demonstrated that stem length, CBR, CFI, age and gender were not risk factors for PPFx. Conclusions: Taperloc Microplasty and complete stems had similar rates of PPFx, and stem length was not a risk factor for a PPFx during uncemented THA.