Does a Triple-Wedge, Broach-Only Stem Design Reduce Early Postoperative Fracture in Anterior Total Hip Arthroplasty?

Introduction: The direct anterior (DA) approach for total hip arthroplasty (THA) is gaining popularity; however, this approach still poses a higher risk for femoral complications, including fracture. The design of cementless stems can also impact the risk of fracture. The purpose of this study is to evaluate the early postoperative femoral complications with a short, triple-wedge broach-only tapered stem used in primary THA via a DA approach.

Materials And Methods: A retrospective review of our institution's arthroplasty registry from 2015 through 2018 was performed to identify all patients who underwent a primary total hip arthroplasty via a direct anterior approach with the Klassic® Blade Stem (Total Joint Orthopedics, Inc., Salt Lake City, Utah). Patients were excluded if the stem was used for a revision surgery, within 90 days of surgery, or if research consent was refused. Two-hundred forty-five patients (289 hips) met inclusion criteria. Clinical and operative notes were reviewed, along with postoperative radiographs.

Results: Average follow up was 0.6 years (range, 0.25 to 3.6 years). Mean patient age was 62.9 years and mean body mass index (BMI) was 29.4 kg/m2. Gender was male in 130 patients (53%) and female in 115 patients (47%). No patients sustained an early postoperative periprosthetic femur fracture. No femoral revisions have been performed at most recent follow up. All 150 patients with >90-day postoperative radiographs demonstrated bony ingrowth of the stem. Early outcomes scores showed a mean postoperative Harris Hip Scores (HHS) of 80.1 (range, 10 to 100) and a pain score of 35.9 (range, 0 to 44).

Conclusion: This triple-wedge broach-only implant demonstrated low rates of early perioperative femoral complications in primary THA via a direct anterior approach. The authors will continue to monitor the longer-term survival and patient outcomes with this implant.