Periprosthetic femoral fracture following primary hip arthroplasty
The Bone & Joint Journal · 1 Nov 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Periprosthetic femoral fracture is a leading cause of reoperation after hip arthroplasty, and these data suggest stem choice may need to be tailored to the patient's sex, age, and frailty.
The evidence
This Norwegian registry study followed 204,041 primary hip replacements and hemiarthroplasties (2005 to 2025) to see how femoral stem design and fixation, analysed separately by sex and age, relate to reoperation for a fracture around the stem. Cemented composite beam stems (Lubinus SPII) had the lowest risk overall. In males, cemented polished taper-slip stems had about nine times the adjusted hazard compared with composite beam stems (aHRR 9.4, 95% CI 5.4 to 16.3), uncemented collarless stems were similar, and uncemented collared stems were about four times higher; age thresholds for increased risk differed by sex and stem type.
Reoperation for periprosthetic femoral fracture (males, PTS vs cemented composite beam): Hazard ratio 9.4 (95% CI 5.4 to 16.3; ratio). The interval favours the comparator; the size of the disadvantage needs clinical interpretation.
Why this rigour score?
Registry cohort (adjusted)Design starting point: 37.4
Raised the score
- Competing risks handled+4.3
- 97% registry capture+3.9
Lowered the score
- Cases were selected rather than consecutive−5.1
- No correction for multiple comparisons−3.4
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot reported
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 37.4
- Aligned time zero
- +2.5
- Compared against an accepted alternative
- +1.7
- Validated coding algorithm
- +2.5
- 97% registry capture
- +3.9
- 58-month follow-up
- −0.4
- No correction for multiple comparisons
- −3.4
- Cases were selected rather than consecutive
- −5.1
- Competing risks handled
- +4.3
- Journal prior (not an observed method)
- +1.6
- Final rigour score rounded
- 45 / 100
Study design sets the starting point and a ceiling of 80. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.For a 78-year-old man with a displaced femoral neck fracture, how would these findings influence whether you choose a cemented composite beam, a cemented polished taper-slip, or an uncemented collared stem?
2.If uncemented collared stems performed similarly to composite beam stems in younger, robust patients, how would you counsel a 60-year-old with osteoarthritis about stem options and fracture risk?
Original publication title
Periprosthetic femoral fracture following primary hip arthroplasty