Post-operative peri-prosthetic fracture rates following the use of cemented polished taper-slip stems for primary total hip arthroplasty: a systematic review.

INTRODUCTION: Peri-prosthetic fractures (PPFs) are a serious complication of total hip arthroplasty (THA) associated with significant morbidity, mortality and re-operation similar to the rates seen following femoral neck fractures. When exploring the PPF rates around cemented stems, many studies combine the results of composite beam and taper-slip stems despite their different philosophies. This review looks specifically at PPFs with the use of cemented stems of the taper-slip philosophy to evaluate the demographics, PPF rate and fracture patterns in this patient cohort.

MATERIALS AND METHODS: A systematic search of Embase, Medline and CINAHL databases was performed to seek studies involving the use of cemented, polished, taper-slip stems, reporting on a rate of post-operative PPF and not involving patient cohorts that were exclusively hip fracture or revision arthroplasty.

RESULTS: 27 studies reported on 505 PPFs with an average time from primary operation to PPF of 71.2 months (2-301 months). The average age of patients who sustained PPFs was 70.6 years (53.5-82 years) and the majority were female (64.2%). The Vancouver B2 fracture type was most common (39.5%). Open reduction and internal fixation represented the management of choice in 61.2% of PPFs. There was a re-operation rate of 11.4%.

CONCLUSION: This review suggests an association with being older and female, and a greater risk of PPFs secondary to low energy falls in cemented polished taper-slip stems.