Does a Collar Reduce Revision Rates and Periprosthetic Fractures in Femoral Neck Fractures? A Comparative Cohort Study of 5,189 Stems - 04/11/25

Doi : 10.1016/j.otsr.2025.104545

Ceyran Hamoudi ^a,^b,^c,⁎ , Fatos Ramadani ^b, Jean-Francois Fischer ^a, Laurent Mustaki ^a, Olivier Husmann ^a, Lada Eberlova ^c, Alexandre Lunebourg ^a
^a Department of Orthopaedics and Traumatology, Etablissement du Nord Vaudois, Yverdon-les-Bains, Switzerland
^b Department of Orthopaedics and Traumatology, Fribourg Cantonal Hospital, Fribourg, Switzerland
^c Department of Anatomy, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 04 November 2025

Abstract

Background

Cemented stems are currently recommended for the treatment of displaced femoral neck fractures (FNFs) due to their reduced risk of revision and periprosthetic fractures (PPF). However, cementless stems with a collar may enhance implant stability. This study assessed the effect of collar addition on revision rates and implant survival in conventional total hip arthroplasty (THA), double mobility THA (THA DM) or hemiarthroplasty (HA) for FNFs.

Hypothesis

We hypothesized that the presence of a collar on cementless stems could play a protective role against both all-cause and periprosthetic fracture revision risk in FNFs.

Methods

A total of 5,189 hip procedures for FNFs, recorded by the Swiss National Joint Registry between 2012 and 2023, were included. Patients received Corail™ collarless cementless (n = 900), collared cementless (n = 2,028), and cemented stems (n = 2,261). Cumulative percent revision (CPR) was calculated for all-cause revision and revision for PPF. Hazard ratios (HRs) with 95% confidence interval were estimated with adjustment for age, gender, BMI, ASA scores, approach, and size of stems to compare revision risk among the three groups. Subgroup analyses were performed among implant types: HA, THA DM, and THA.

Results

Cemented stems had a lower all-cause revision rate than collarless stems (3.2 versus 6.9%, p < .001) and for PPF (0.5 versus 2.9%, p < .001). However, no statistical difference was found when cemented stems were compared with collared stems. After adjustment, collarless stems showed a significantly higher risk of all-cause revision (HR: 1.91 (1.30–2.79], p < .001) and PPF (HR: 5.82 (2.68–12.67], p < .001) compared with cemented stems. No significant difference was found between collared and cemented stems. Increased ASA, BMI 30–34.9, and posterior approach also predicted higher revision risk. In subgroup analyses, cemented and collared stems were consistently associated with a lower or equivalent risk of all-cause revision compared to collarless cementless stems regardless of the implant type.

Conclusion

Collared and cemented stems demonstrated equivalent and superior implant survival compared to collarless stems for both all-cause and PPF revisions. Collared stems appear to be a viable alternative to cemented stems when treating FNFs.

Level of evidence

III.

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Keywords : Total hip replacement, Hemiarthroplasty, Femoral neck fracture, Revision rate, Periprosthetic fractures, Cementless, Cemented, Collared stems