Collared Cementless Stems Show Equivalent Rates of Periprosthetic Fractures Compared to Collarless Cemented Stems in an Exclusively Elderly Cohort of Patients

Dongyeon Joanna Kim; Alexander S Dash; Anastasia Gazgalis; Lauren Burgett; Erik Williams; Jeffrey A Geller

doi:10.1016/j.arth.2026.03.044

Collared Cementless Stems Show Equivalent Rates of Periprosthetic Fractures Compared to Collarless Cemented Stems in an Exclusively Elderly Cohort of Patients

J Arthroplasty. 2026 Apr 1:S0883-5403(26)00238-X. doi: 10.1016/j.arth.2026.03.044. Online ahead of print.

Authors

Dongyeon Joanna Kim¹, Alexander S Dash¹, Anastasia Gazgalis¹, Lauren Burgett¹, Erik Williams¹, Jeffrey A Geller¹

Affiliation

¹ Columbia University, Department of Orthopaedic Surgery, New York, New York.

PMID: 41997809
DOI: 10.1016/j.arth.2026.03.044

Abstract

Background: The optimal femoral stem fixation for total hip arthroplasty for older patients remains debated due to the heightened risk of periprosthetic fractures (PPFx) with decreased bone density. Previous studies in elderly patients have shown cemented fixation leads to fewer revisions, reduced PPFx, and improved long-term implant survival. We hypothesized that modern collared cementless stems would reduce PPFx and overall complications compared to cemented and uncemented collarless stems. To our knowledge, this study represents the first single-center analysis of outcomes in older patients traditionally recommended for cemented fixation.

Methods: We retrospectively analyzed our institutional database to identify all primary total hip arthroplasties performed for women over 70 years of age and men older than 75 years between January 1, 2013 and December 31, 2024. Patients were categorized by stem collar presence and fixation method. Complications (PPFx, dislocations, periprosthetic joint infection, and aseptic loosening), reoperation indication, time to reoperation, and patient-reported outcomes were analyzed.

Results: Surgical time was shortest in the collared/cementless group and demonstrated the greatest and most sustained improvements in patient-reported outcomes (P-values < 0.05). The most common complication was PPFx (n = 17, 65.4%), primarily occurring in collarless/cementless designs. Collared/cementless stems had fewer complications (P = 0.0003), revisions (P = 0.004), and PPFx (P = 0.007) than collarless/cementless stems. Collared/cementless stems were noninferior in PPFx protection compared to collarless/cemented stems (P > 0.05) and demonstrated equivocal revision and complication rates compared to all cemented stems (P = 0.22).

Conclusion: Collared/cementless stems were associated with fewer PPFx and a lower overall complication rate when compared to collarless/cementless stems. Collared/cementless stems were also noninferior to cemented stems, both with and without a collar, for complication rates and PPFx rates. Thus, a modern collared/cementless stem may offer a viable alternative to cemented fixation in osteoporotic patients.

Keywords: cementless stem; collared stem; hip arthroplasty; periprosthetic fracture; revisions; survivorship.