Journal of Orthopaedic Science · Nov 2026
Multicenter retrospective study on the efficacy of reconstruction using a polished taper cemented stem for periprosthetic femoral fractures following total hip arthroplasty and hemiarthroplasty
By Kadowaki M, Fujita H, Iwase T et al.
Background Periprosthetic femoral fractures (PPF) after hip arthroplasty are serious, with high complication rates, poor outcomes, and increased mortality. Surgical options include osteosynthesis and revision arthroplasty, but optimal management remains controversial. This study aimed to evaluate postoperative clinical and radiological outcomes of revision hip arthroplasty using a polished, tapered cemented stem after total hip arthroplasty or hemiarthroplasty. Methods This study included 38 PPF cases after hip arthroplasty treated with revision using the Exeter stem at five institutions between 2003 and 2024. The mean age at revision surgery was 70.1 years, and the mean follow-up was 56 months. According to the Vancouver classification, fractures were classified as type AL (n = 1), type B1 (n = 10), type B2 (n = 16), and type B3 (n = 11). The re-revision rate, mortality, and functional and radiographic outcomes were assessed. Results Re-revision surgery was performed in three patients (7.9%). The cumulative survival rate, with stem re-revision as the endpoint, was 97.4% at 1 year and 93.1% at 10 years postoperatively. No deaths occurred within 1 year after revision surgery; cumulative survival, with death as the endpoint, was 100% at 1 year, 92.9% at 5 years, and 83.6% at 10 years. At the final examination, 13 cases (34.2%) were able to walk independently, and three (7.9%) used a wheelchair. Radiographic evaluation revealed radiolucency around the stem in five cases. Conclusions Revision surgery using the Exeter stem for PPF demonstrated favorable outcomes, with low re-revision rates and mortality. This technique may be preferable for PPF because a single system accommodates multiple PPF types and is well-suited to the impaction bone grafting procedure for bone defects.