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

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.