Collarless Taper Slip and Collared Composite Beam Stems Differ in Failure Modes and Reoperation Rates

Background: Cemented femoral components are used in older patients based on lower risk of periprosthetic fracture and implant loosening. This study reports the survivorship free of periprosthetic femoral fracture (PPFX), femoral loosening, all-cause revision, and reoperation between 2 philosophies of cemented stems. Methods: In total, 1,306 primary hybrid total hip arthroplasties were performed for osteoarthritis between 2000 and 2018 in a retrospective single center study. Cemented stems included 798 EON composite beam (CB) and 508 Exeter collarless taper slip (CTS) stems. Mean age was 77 years. An inverse treated probability weighted model was utilized to control for risk factors including age, gender, body mass index, year, and surgeon. Results: There was no difference in risk of PPFX at 10 years (CTS 9% vs CB 5%; hazard ratio [HR] 1.4, P =.47). There was an increased risk of intraoperative fractures requiring fixation in the CB cohort (7/798 [5 calcar, 2 greater trochanter] vs 0/508, P <.001), while there was an increased risk of Vancouver B₂ PPFX in the CTS cohort (7/508 vs 0/798; P < 001). There was a higher risk of femoral loosening in the CB cohort (6/798 vs 0/508; P <.0001). Higher survivorship free of revision (98% vs 91%; HR 4, P =.001) and free of reoperation (96% vs 88%; HR 2.5, P =.002) was seen at 10 years in the CB cohort. Conclusion: The risk of PPFX requiring implant revision was increased in the CTS cohort, while there was an increased risk of femoral component loosening and intraoperative fractures seen in the CB cohort. Surgeons should be aware of the different failure modes when choosing implant design for their patient.