A Modern Collared Cementless Femoral Stem for the Arthroplasty Treatment of Femoral Neck Fractures

<b>Background/Objectives</b>: For femoral neck fractures (FNFs) treated with hip arthroplasty, cemented femoral fixation is frequently recommended due to its association with reduced early perioperative fracture and reoperation rates. However, newer-generation collared, cementless triple-tapered (CCTT) stems may present benefits compared with conventional press-fit designs. This study sought to assess 30-day survivorship of a CCTT stem in patients undergoing hip arthroplasty for FNF via the direct anterior approach (DAA). <b>Methods</b>: We conducted a retrospective review of all patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for displaced FNF from 2019 to 2023. All procedures were performed through the DAA using a hydroxyapatite-coated CCTT femoral stem. The primary outcome was 30-day stem survival. Secondary outcomes included reoperation, stem revision, complications, readmission, and radiographic outcomes including intraoperative and postoperative periprosthetic fracture and subsidence. <b>Results</b>: A total of 184 patients were included (mean age 76.1 ± 10.0; 70.1% women). THA was performed in 77.7% and HA in 22.3%. At 30 days, no stems required revision. The 30-day reoperation rate was 3.5% (5/184). There were four intraoperative fractures: 3 (1.6%) Vancouver AG and 1 (0.5%) calcar. Postoperatively within 3 months, seven fractures occurred: five (2.7%) Vancouver AG and two (1.1%) Vancouver B1. <b>Conclusions</b>: Use of a modern CCTT femoral stem for FNF demonstrated excellent early survivorship with low rates of intraoperative and postoperative periprosthetic fracture, comparable to published outcomes of cemented fixation. These findings suggest that this stem design may represent a safe and efficient alternative to cemented femoral fixation in FNF. Further studies are warranted to evaluate mid- and long-term outcomes.