Impact of femoral component design on periprosthetic fracture risk in total hip arthroplasty

Listen to Brian and Lisa discuss the paper 'Impact of femoral component design on periprosthetic fracture risk in total hip arthroplasty' published in the December 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper 'Impact of femoral component design on periprosthetic fracture risk in total hip arthroplasty', published in December 2025 by GS Turnbull and colleagues. I'm Simon, and I'm joined by my co-host Amy.

Hello everyone, glad to be here. So Simon, this study explores the intricacies of femoral component design and its impact on periprosthetic fracture risk in total hip arthroplasty or THA. Shall we start with the motivation behind this research?

The primary drive was the recognized complication of postoperative periprosthetic femoral fractures or POPFF following THA. Despite advancements in THA, the clinical burden of revision total hip arthroplasty and POPFFs has risen. With people living longer, more patients outlive their implants, increasing the necessity for revision surgeries. Moreover, [00:01:00] projections indicate postoperative PFFs are to increase by 4.6% every decade over the next 30 years. This underscores the importance of strategies to mitigate POPFF risk.

Indeed, the study aims to compare the medium-term survivorship and the rate of POPFF between two types of femoral components, the polished taper slip or PTS and the composite beam. To do this, the researchers carried out a retrospective cohort study involving 3,198 cemented THAs performed between January 2008 and December 2013. The study took place in two centres using either the Exeter V40 PTS component or the Lubinus SP II composite beam component.

Patient demographic details and operative specifics were meticulously collected. These records along with radiological archives were reviewed at a minimum of ten years post-surgery to identify instances of revision surgery, dislocation, or POPFF.[00:02:00] 

At a median follow-up of 12 years, 2,214 patients remained alive. The study noted that PTS components had a survivorship of 96.6% while the composite beam components had an impressive 99.5% survivorship. Yes, and the POPFF rates were particularly striking. The PTS group had a significantly higher risk of POPFF with such fractures accounting for 48% of reoperations in this group compared to just 13% in the composite beam group.

Furthermore Amy, 85% of the postoperative PFFs in the PTS group underwent open reduction and internal fixation or ORIF. The multivariate analysis supported this finding, showing PTS femoral components with a hazard ratio of 5.17 were significantly more prone to P-A-POPFF. Additionally, older patient age at surgery was another risk factor with a hazard ratio of 3.18.

That's an essential point, Simon. [00:03:00] Interestingly, the composite Beam Group exhibited a higher dislocation rate of about 1.5% compared to only 0.75% in the PTS group. This highlights the trade off between different risks in medical decisions. Definitely the study underscores how different femoral component designs can impact patient outcomes In THA.

The anatomical design of the composite beam femoral component seems to reduce POPFF risk, while the PTS design has other established benefits, despite its higher POPFF risk. In summary, the key takeaway is that while both PTS and composite beam femoral components show excellent overall survivorship planning implant choices in THA should consider specific POPFF risks, particularly in older patients. Would you agree, Simon?

Absolutely. Amy. This research provides invaluable insights into the long-term performance of these femoral components and highlights the importance of personalized treatment plans in orthopaedic [00:04:00] surgery. 

Well, that's all for today's episode of AI Talks With Bone & Joint. Thank you for joining us, and a big thanks to GS Turnbull and his team for their research. Until next time.