Outcomes of 1,021 consecutive cases utilizing a triple tapered collared stem and automated broaching system

Abstract

Background: For total hip arthroplasty (THA), a number of different femoral stem designs exist, each offering potential benefits and risks to patients. Preparation and implantation of the femoral component may be performed with manual instrumentation or with automated broaching systems. The combination of stem and femoral preparation choice may influence patient outcomes. The purpose of this study was to report on a large consecutive series of a collared, triple tapered, cementless stem broached and impacted with an automated system through a mini-posterior approach. Methods: 1021 consecutive THAs with a cementless triple-tapered fully coated titanium femoral stem performed by a single surgeon via a minimally invasive posterior approach all utilizing automated broaching (AB) were collected retrospectively. Patient demographic data, proximal femoral anatomical features, radiographic outcomes (e.g., subsidence), PROMIS scores, and intra-operative and postoperative complications were collected and analyzed. Results: 7/1021 (0.68%) intra-operative calcar fractures and 11/1021 (1.08%) postoperative periprosthetic femoral fractures were observed. The average postoperative subsidence was 0.5 mm. Subsidence was not associated with age, BMI, or proximal femoral anatomy (Dorr C). There were no revisions for postoperative mechanical loosening or instability. No increase in periprosthetic fracture was noted amongst the first 100 cases using AB (0/100) when compared to the subsequent 100 (0/100). All patients experienced statistically significant improvement in PROMIS scores postoperatively at 1-year follow-up. Conclusion: This large, consecutive, single surgeon series demonstrates excellent results of the aforementioned stem prepared and impacted with AB. At mid-term follow-up, there were no revisions for mechanical loosening and all-cause survivorship was 98.2%.