Aims Polished taper slip (PTS) designs are widely used in cemented hip hemiarthroplasty for displaced intracapsular native hip fractures (NHFs), though concerns persist regarding PTS association with higher postoperative periprosthetic femoral fracture (POPFF) risk. The aim of this study was to evaluate the performance of the Exeter V40 cemented femoral component in the management of NHFs. This study prioritized evaluating survival, reoperations of the index hip joint, and major complications including intraoperative periprosthetic femoral fracture (IOPFF), POPFF, infection, and dislocation. Methods This retrospective cohort study included consecutive patients who underwent hip hemiarthroplasty with the Exeter V40 PTS femoral component for NHF at a single hospital between 1 February 2016 and 30 June 2024. Patient demographic details, time to theatre, surgical and medical management, American Society of Anesthesiologists grade, and mortality were collected. Reoperation and mortality were calculated to final follow-up. Cox regression analysis was performed to identify independent associations with revision or fixation adjusted for confounders. Results A total of 3,050 hip hemiarthroplasties in 2,948 patients were identified (69% female, median age 83 years (IQR 76 to 88)). Overall, 75 patients (2.5%) required reoperation, yielding a prosthesis-time incidence rate per 1,000 prosthesis-years (PTIR) of 10.7 (95% CI 8.4 to 13.4), with POPFF PTIR 5.1 per 1,000 prosthesis-years, infection PTIR 3.43 (95% CI 2.20 to 5.10), and dislocation PTIR 3.28 (95% CI 2.08 to 4.93). Male sex was an independent predictor of poor survival, with an adjusted hazard ratio of 2.85 (95% CI 1.76 to 4.60). Intraoperative fracture incidence was 0.9%, with the majority occurring at trial reduction (0.6%). Survival of the Exeter V40 femoral component was 97.6% (95% CI 96.9 to 98.4) at three years. Conclusion The Exeter V40 femoral component demonstrates acceptable performance in hip hemiarthroplasty for NHF, with low rates of POPFF and femoral component revision. Male sex is an independent risk factor for reoperation of the index hip joint. Surgeons should exercise caution during trial reduction to minimize intraoperative fracture risk. These findings support its continued use in hip hemiarthroplasty for elderly patients. Cite this article: Bone Joint J 2026;108-B(2):226–233.
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