This systematic review aggregated PFF data from 34 studies and 342,719 primary THAs to examine how femoral implant geometry affects fracture risk. It is the first systematic review specifically linking stem design category to PFF incidence. The central question: do certain stem geometries independently drive the rising rate of periprosthetic femoral fractures?
Choosing a femoral stem is not just about fixation philosophy — stem geometry is an independent, modifiable risk factor for periprosthetic fracture.
When you are planning a primary THA in an elderly patient with osteoporotic bone or a femoral neck fracture, this paper is why you reach for a cemented composite-beam stem or, if going cementless, a Type 3 or Type 4 design rather than a fit-and-fill stem.
For cemented cases, the anatomical Lubinus-type composite-beam stem produces a more consistent cement mantle than straight Charnley-type designs. A technical detail worth knowing when you discuss long-term PFF prevention.
The finding that late PFF occurs years after successful osseointegration means you cannot reassure a patient that being two years out from a cementless THA eliminates fracture risk. Counsel accordingly and maintain a low threshold for imaging new thigh pain.
This systematic review aggregated PFF data from 34 studies and 342,719 primary THAs to examine how femoral implant geometry affects fracture risk. It is the first systematic review specifically linking stem design category to PFF incidence. The central question: do certain stem geometries independently drive the rising rate of periprosthetic femoral fractures?
Choosing a femoral stem is not just about fixation philosophy — stem geometry is an independent, modifiable risk factor for periprosthetic fracture.
When you are planning a primary THA in an elderly patient with osteoporotic bone or a femoral neck fracture, this paper is why you reach for a cemented composite-beam stem or, if going cementless, a Type 3 or Type 4 design rather than a fit-and-fill stem.
For cemented cases, the anatomical Lubinus-type composite-beam stem produces a more consistent cement mantle than straight Charnley-type designs. A technical detail worth knowing when you discuss long-term PFF prevention.
The finding that late PFF occurs years after successful osseointegration means you cannot reassure a patient that being two years out from a cementless THA eliminates fracture risk. Counsel accordingly and maintain a low threshold for imaging new thigh pain.