Collared Cementless Femoral Components Reduce the Revision Rates in Primary Total Hip Arthroplasty Using the Direct Anterior Approach: An Australian Orthopaedic Association National Joint Replacement Registry Study

Siddharth Rele; Edward O'Bryan; Carl Holder; Peter L Lewis; Claudia Di Bella

doi:10.1016/j.arth.2024.05.009

Collared Cementless Femoral Components Reduce the Revision Rates in Primary Total Hip Arthroplasty Using the Direct Anterior Approach: An Australian Orthopaedic Association National Joint Replacement Registry Study

J Arthroplasty. 2024 May 10:S0883-5403(24)00442-X. doi: 10.1016/j.arth.2024.05.009. Online ahead of print.

Authors

Siddharth Rele¹, Edward O'Bryan², Carl Holder³, Peter L Lewis⁴, Claudia Di Bella⁵

Affiliations

¹ University of Melbourne Department of Surgery, St Vincent's Hospital, Fitzroy 3065. Electronic address: sid.rele@unimelb.edu.au.
² Alfred Health, Melbourne 3004. Electronic address: e.obryan@icloud.com.
³ South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia. Electronic address: carl.holder@sahmri.com.
⁴ Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia; University of Adelaide Medical School, Adelaide, South Australia. Electronic address: plewis@aoanjrr.org.au.
⁵ Department of Surgery, The University of Melbourne, Eastern Hill Campus, Fitzroy 3065; Department of Orthopaedics, St Vincent's Hospital Melbourne, Fitzroy 3065; Victorian Bone and Joint Specialists, Fitzroy 3065. Electronic address: claudia.dibella@unimelb.edu.au.

PMID: 38735543
DOI: 10.1016/j.arth.2024.05.009

Abstract

Background: An increased risk of periprosthetic fracture and aseptic loosening is reported when the direct anterior approach (DAA) is used for total hip arthroplasty (THA), especially with cementless implants. We assessed the rate of revision comparing collared and collarless femoral stems when using the DAA for THA.

Methods: We used data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) for primary THA for osteoarthritis inserted with the DAA between January 2015 and December 2022. There were 48,567 THAs that used the DAA (26,690 collarless cementless, 10,161 collared cementless, and 11,716 cemented). Cumulative percent revision (CPR) was calculated for all-cause revision, revision for periprosthetic femoral fractures, and aseptic femoral stem loosening. Cox proportional hazard ratios were used to compare the revision of collared and collarless cementless stems. We also compared collared cementless stems and cemented stems.

Results: A higher rate of all-cause revision within three months of surgery was observed with collarless compared to collared cementless implants (HR [hazard ratio]: 1.99 [95% CI (confidence interval), 1.56 to 2.54]; P < 0.001). Similarly, collarless cementless implants were associated with a greater rate of revision for fracture in the first six months (HR: 2.90 [95% CI, 1.89 to 4.45]; P < 0.001) and after 6 months (HR 10.04 [95% CI 1.38 to 73.21]; P = 0.02), as well as an increased rate of revision for aseptic loosening after two years (HR: 5.76 [95% CI, 1.81 to 18.28], P = 0.003). Collared cementless and cemented stems performed similarly.

Conclusion: Collared stems were associated with a reduced rate of all-cause revision for cementless THA performed via the DAA. The reduction in risk may be due to protection from periprosthetic femoral fracture and aseptic loosening.

Keywords: Revision; cementless stems; collared stems; direct anterior approach; total hip arthroplasty.