Low-Demand Cemented Femoral Stem Designs and Revision Risk Following the Hemiarthroplasty Treatment of Geriatric Hip Fracture

Kanu Okike; Heather A Prentice; Elizabeth W Paxton; Brian H Fasig; Ishan Shah; Christopher D Grimsrud; Foster Chen

doi:10.5435/JAAOS-D-24-00985

Low-Demand Cemented Femoral Stem Designs and Revision Risk Following the Hemiarthroplasty Treatment of Geriatric Hip Fracture

J Am Acad Orthop Surg. 2025 Jan 14. doi: 10.5435/JAAOS-D-24-00985. Online ahead of print.

Authors

Kanu Okike¹, Heather A Prentice, Elizabeth W Paxton, Brian H Fasig, Ishan Shah, Christopher D Grimsrud, Foster Chen

Affiliation

¹ From the Hawaii Permanente Medical Group, Kaiser Permanente, Honolulu, HI (Okike), the Department of Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA (Prentice, Paxton, and Fasig), the San Francisco Orthopaedic Residency Program, San Francisco, CA (Shah), the Permanente Medical Group, Oakland, CA (Grimsrud), and the Washington Permanente Medical Group P.C, Seattle, WA (Chen).

PMID: 39819777
DOI: 10.5435/JAAOS-D-24-00985

Abstract

Background: Cemented fixation is recommended in the hemiarthroplasty treatment of geriatric femoral neck fractures. Certain cemented stems have similarly designed "low-demand" counterparts, but it is unclear whether they yield comparable clinical outcomes. The purpose of this study was to evaluate the revision risk associated with two low-demand stems, Summit Basic (DePuy Synthes) and Versys LD/Fx (Zimmer Biomet), in comparison to their standard counterparts, Summit (DePuy Synthes) and Versys Advocate (Zimmer Biomet).

Methods: Using our U.S. integrated healthcare system's Hip Fracture Registry, we identified patients aged ≥60 years who were treated with one of these four cemented hemiarthroplasty devices (2009-2022). Low-demand stems were compared with standard stems on the basis of aseptic revision rates (primary outcome measure) as well as periprosthetic fracture and 90-day complications (secondary outcome measures). Multivariable Cox proportional hazards regression was used to adjust for potential confounders.

Results: Overall, there were 9,828 cemented hemiarthroplasties (69.0% female, 78.9% White), including 3,713 low-demand stems and 6,115 standard stems. In the adjusted analysis, low-demand stems were associated with a higher risk of aseptic revision compared with standard designs (hazard ratio [HR] 1.53, 95%CI 1.06-2.22, P = 0.024). This difference was driven primarily by a higher risk of periprosthetic fracture in the low-demand stems (HR 3.40, 95%CI 1.54-7.51, P = 0.003). Similar findings were observed when separately comparing Summit Basic with Summit and Versys LD/Fx to Versys Advocate, and when restricting to procedures performed by experienced total hip arthroplasty surgeons.

Conclusions: In this study of 9,828 hip fracture patients treated with cemented hemiarthroplasty, low-demand stems were associated with a higher risk of aseptic revision as compared with their standard counterparts. Further research is required to determine the features of the low-demand stems which could be contributing to this finding, as well as the circumstances under which usage of low-demand stems could still be justified based on cost.