Bone Quality vs. Stem Fixation: Solving the Fracture Problem in Fracture THA

Exploring the structural impact of proximal femoral morphology and Dorr bone typing to determine what actually drives implant survivorship in trauma THA.

Femoral neck fractures remain a massive healthcare challenge in the elderly population, serving as a primary driver of major patient morbidity and post-surgical mortality. While treatment ranges from internal fixation to hemiarthroplasty, total hip arthroplasty (THA) has expanded significantly as a premier option to restore high-level function and long-term quality of life. Currently, the American Academy of Orthopaedic Surgeons clinical practice guidelines note moderate evidence favoring cemented femoral stems for hip fractures.

However, nearly all of the historical literature backing that consensus was derived strictly from hemiarthroplasty series. In the United States, an “uncemented paradox” persists: despite registry data warning of complications, the vast majority of trauma THAs are performed using cementless femoral stems. Advocates argue that press-fit implants mitigate the risks of cemented hips, such as extended operative times, increased baseline implant costs, and bone cement implantation syndrome (BCIS). We set out to evaluate whether this massive national shift toward cementless stems is truly safe when performing a full THA for acute hip fractures.