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The cementless taper wedge vs. fit-and-fill stem in primary total hip arthroplasty: risk of stem-related complication differs across Dorr types

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The choice between a cementless taper wedge stem and a fit-and-fill stem in total Hip arthroplasty (THA) for various proximal femoral morphological types has not been thoroughly evaluated. This study aimed to compare the risk of stem-related complications between these two stem types in Dorr type A, B, and C femurs.

Materials and Methods

From January 2015 through April 2021, we retrospectively reviewed 1995 cementless THA procedures. We stratified all procedures into three groups: Dorr type A (N = 360, 18.0%), B (N = 1489, 74.7%) and C (N = 146, 7.3%). The primary outcome domain was stem-related complications, including stem subsidence ≥ 3 mm, intraoperative fracture, periprosthetic fracture and aseptic stem loosening. We performed multivariate regression analysis to compare the risk of stem-related complication between the two stem types. Other factors included age, sex, body mass index, diagnosis, age-adjusted Charlson comorbidity index, stem alignment and canal fill ratio.

Results

The incidence of stem-related complications in the taper wedge and fit-and-fill stem groups was 4.4% (N = 15) and 6.5% (N = 107), respectively. Fit-and-fill stems showed an increased risk of stem-related complications (aOR: 9.903, 95% CI: 1.567–62.597) only in Dorr type C femurs. No significant difference in risk was observed in Dorr type A and B femurs. Furthermore, the canal fill ratio at the lesser trochanter, 2 cm and 7 cm below the lesser trochanter, did not exhibit an association with stem-related complications in any Dorr type.

Conclusions

Concerning the risk of stem-related complications, the taper wedge stem was a better choice in Dorr type C femurs. However, there was no difference in risk between the taper wedge stem and fit-and-fill stem in Dorr type A and B femurs.

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Data availability

The data of this study are available upon request from the corresponding author.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan

    Kun-Han Lee, Yueh-Ting Hung, Cheng-Yang Chang, Jui-Chien Wang, Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu & Wei-Ming Chen

  2. Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Kun-Han Lee, Yueh-Ting Hung, Cheng-Yang Chang, Jui-Chien Wang, Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu & Wei-Ming Chen

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  1. Kun-Han Lee
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Correspondence to Shang-Wen Tsai.

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The ethics committee and institutional review board of Taipei Veterans General Hospital approved this study (2023–011-001BC). The requirement for informed consent was waived due to the retrospective nature of the study. The authors declare that they have no conflicts of interest.

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Lee, KH., Hung, YT., Chang, CY. et al. The cementless taper wedge vs. fit-and-fill stem in primary total hip arthroplasty: risk of stem-related complication differs across Dorr types. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05361-y

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