The cementless taper wedge vs. fit-and-fill stem in primary total hip arthroplasty: risk of stem-related complication differs across Dorr types

Kun-Han Lee; Yueh-Ting Hung; Cheng-Yang Chang; Jui-Chien Wang; Shang-Wen Tsai; Cheng-Fong Chen; Po-Kuei Wu; Wei-Ming Chen

doi:10.1007/s00402-024-05361-y

The cementless taper wedge vs. fit-and-fill stem in primary total hip arthroplasty: risk of stem-related complication differs across Dorr types

Arch Orthop Trauma Surg. 2024 May 13. doi: 10.1007/s00402-024-05361-y. Online ahead of print.

Authors

Kun-Han Lee^{1

2}, Yueh-Ting Hung^{1

2}, Cheng-Yang Chang^{1

2}, Jui-Chien Wang^{1

2}, Shang-Wen Tsai^{3

4}, Cheng-Fong Chen^{1

2}, Po-Kuei Wu^{1

2}, Wei-Ming Chen^{1

2}

Affiliations

¹ Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan.
² Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan. swtsai.vghtpe@gmail.com.
⁴ Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. swtsai.vghtpe@gmail.com.

PMID: 38739153
DOI: 10.1007/s00402-024-05361-y

Abstract

Introduction: The choice between a cementless taper wedge stem and a fit-and-fill stem in total Hip arthroplasty (THA) for various proximal femoral morphological types has not been thoroughly evaluated. This study aimed to compare the risk of stem-related complications between these two stem types in Dorr type A, B, and C femurs.

Materials and methods: From January 2015 through April 2021, we retrospectively reviewed 1995 cementless THA procedures. We stratified all procedures into three groups: Dorr type A (N = 360, 18.0%), B (N = 1489, 74.7%) and C (N = 146, 7.3%). The primary outcome domain was stem-related complications, including stem subsidence ≥ 3 mm, intraoperative fracture, periprosthetic fracture and aseptic stem loosening. We performed multivariate regression analysis to compare the risk of stem-related complication between the two stem types. Other factors included age, sex, body mass index, diagnosis, age-adjusted Charlson comorbidity index, stem alignment and canal fill ratio.

Results: The incidence of stem-related complications in the taper wedge and fit-and-fill stem groups was 4.4% (N = 15) and 6.5% (N = 107), respectively. Fit-and-fill stems showed an increased risk of stem-related complications (aOR: 9.903, 95% CI: 1.567-62.597) only in Dorr type C femurs. No significant difference in risk was observed in Dorr type A and B femurs. Furthermore, the canal fill ratio at the lesser trochanter, 2 cm and 7 cm below the lesser trochanter, did not exhibit an association with stem-related complications in any Dorr type.

Conclusions: Concerning the risk of stem-related complications, the taper wedge stem was a better choice in Dorr type C femurs. However, there was no difference in risk between the taper wedge stem and fit-and-fill stem in Dorr type A and B femurs.

Keywords: Cementless stem; Complication; Dorr classification; Proximal femoral morphology; Subsidence; Total hip arthroplasty.