{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T13:55:23Z","timestamp":1791035723493,"version":"4.1.0"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Concordia Foundation"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HIP International"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Small cementless hydroxyapatite-coated quadrangular tapered femoral stems are at increased risk of revision, but it is unclear whether this holds for appropriately-sized and undersized stems alike. This study aimed to assess the association between stem size and revisions for aseptic loosening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Primary total hip arthroplasties with an Avenir (1547; Zimmer-Biomet), Corail (16,893; DePuy Synthes), or Polarstem (3403; Smith+Nephew) stem during 2012\u20132023 were identified from the Canadian Joint Replacement Registry. Cox proportional hazards models were used to estimate the association between stem\/cup size and revision for aseptic loosening while adjusting for age, sex, and implant characteristics. Standardised stem sizing from A\u2013K (smallest-largest) was utilised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Between different stems, the proportion of size A was 1.2\u20135.0% and of size B 3.6\u201312.2%. \u2153 (21\/63) of aseptic loosening revisions occurred for size A\/B. Increased risk of revision for aseptic loosening for size A stems was found with a hazard ratio (HR) of 46 (95% CI, 9\u2013226) when paired with \u2a7e56-mm cups, 47 (14\u2013157) when paired with 52\u201354-mm cups, and 17 (4\u201378) when paired with \u2a7d50-mm cups (reference size C+ with \u2a7e56-mm cups). Size B stems were also at increased risk of aseptic loosening, with an HR of 15 (95% CI, 4\u201352) and 9 (95% CI, 3\u201332) for \u2a7e56 and 52\u201354-mm cups respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The increased risk of revision of these small stems camouflages a highly increased risk of revision for aseptic loosening in undersized stems (small stem\/big cup). This study was unable to ascertain whether this applies to other quadrangular tapered stems. Due to the small number of affected patients, it is important to repeat this study in other jurisdictions. Surgeons should be skeptical if a smaller size stem seems appropriate during broaching than preoperative templating or cup size suggests, as this may increase the risk of aseptic loosening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11207000261475482","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:27:16Z","timestamp":1790749636000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Aseptic loosening of small hydroxyapatite-coated quadrangular tapered femoral stems: camouflage in the Canadian Joint Replacement Registry"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8472-932X","authenticated-orcid":false,"given":"Christiaan H","family":"Righolt","sequence":"first","affiliation":[{"name":"Orthopaedic Innovation Centre, Winnipeg, MB, Canada"},{"name":"Department of Surgery, University of Manitoba, Winnipeg, MB, Canada"},{"name":"College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada"},{"name":"Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colton","family":"Poitras","sequence":"additional","affiliation":[{"name":"Orthopaedic Innovation Centre, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Bansal","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Manitoba, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin D","family":"Burnell","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Manitoba, Winnipeg, MB, Canada"},{"name":"Concordia Joint Replacement Group, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1605-0753","authenticated-orcid":false,"given":"Thomas R","family":"Turgeon","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Manitoba, Winnipeg, MB, Canada"},{"name":"Concordia Joint Replacement Group, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3973-0794","authenticated-orcid":false,"given":"Eric R","family":"Bohm","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Manitoba, Winnipeg, MB, Canada"},{"name":"Concordia Joint Replacement Group, Winnipeg, MB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"NJR. National Joint Registry: 21st Annual Report 2024 https:\/\/reports.njrcentre.org.uk\/Portals\/0\/PDFdownloads\/NJR%2021st%20Annual%20Report%202024.pdf (2024 accessed 8 July 2025)."},{"key":"e_1_3_3_3_2","unstructured":"Smith PN Gill DR McAuliffe MJ et al. Hip knee and shoulder arthroplasty: 2023 annual report. Adelaide South Australia: Australian Orthopaedic Association National Joint Replacement Registry AOA https:\/\/aoanjrr.sahmri.com\/annual-reports-2023 (2023 accessed 13 February 2024)."},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.10.060"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B11.BJJ-2017-0431.R1"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-019-1271-1"},{"key":"e_1_3_3_7_2","volume-title":"Data quality documentation for users: Canadian Joint Replacement Registry, 2020\u20132021 Data","author":"Canadian Institute for Health Information","year":"2022","unstructured":"Canadian Institute for Health Information. Data quality documentation for users: Canadian Joint Replacement Registry, 2020\u20132021 Data. Ottawa: CIHI, 2022."},{"key":"e_1_3_3_8_2","volume-title":"Data quality documentation discharge abstract database: current-year information 2023\u20132024","author":"Canadian Institute for Health Information","year":"2024","unstructured":"Canadian Institute for Health Information. Data quality documentation discharge abstract database: current-year information 2023\u20132024. August 2024. Ottawa: CIHI."},{"key":"e_1_3_3_9_2","volume-title":"Data quality documentation national ambulatory care reporting system: current-year information 2023\u20132024","author":"Canadian Institute for Health Information","year":"2024","unstructured":"Canadian Institute for Health Information. Data quality documentation national ambulatory care reporting system: current-year information 2023\u20132024. August 2024. 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