Association of Surgical Approach with Intraoperative Femoral Fracture Patterns During Cementless Hemiarthroplasty for Femoral Neck Fracture

Background/Objective: Intraoperative femoral fractures during cementless hemiarthroplasty may present with distinct anatomical patterns. We examined whether surgical approach was associated with greater trochanteric versus stem-stable periprosthetic fracture patterns in older patients with osteoporotic-type femoral morphology; stem geometry was evaluated as an additional implant-related factor.

Methods

We retrospectively reviewed 292 patients aged ≥75 years who underwent cementless bipolar hemiarthroplasty for low-energy displaced femoral neck fractures at a tertiary referral trauma center between January 2019 and July 2023. Patients were grouped according to stem geometry (fit-and-fill or tapered-wedge) and surgical approach (lateral or posterior). Associations were assessed using multivariable logistic regression, Firth-penalized regression, and stabilized inverse probability of treatment weighting (IPTW).