REDUCED FRACTURES AND STEM SUBSIDENCE AT SIX MONTHS WITH COLLARED STEMS IN DIRECT ANTERIOR CEMENTLESS TOTAL HIP ARTHROPLASTY
Notice bibliographique
Résumé
Many femur fractures in total hip arthroplasty (THA) occur during advancement of the final stem, especially during a direct anterior approach (DAA). Calcar collars are a re-emerging trend among cementless stem designs which may reduce fracture risk by both preventing subsidence and acting as an intraoperative cue for sufficient stem advancement. We hypothesize that collared femoral stems have lower risk of intraoperative and post-op periprosthetic fracture and stem subsidence compared to collarless designs in DAA THA at 6 months. A retrospective review of 348 DAA THAs on a Hana table performed from 2017–2020 by a single surgeon, fellowship trained in arthroplasty, was done. Three cementless stems with similar broach systems were studied: Zimmer ML Taper, Avenir & the Avenir-Complete with a collar. Only patients with Dorr A or B femurs received cementless THA. Incidence of intraoperative fractures and post-operative Vancouver AL/B fractures within 6 months were recorded. Radiographic stem subsidence was measured and compared at 6-months by the attending surgeon and 2 independent observers. Routine 3-dimensional post-operative imaging to quantify subsidence was not feasible at our institution. Fisher-Exact test was used to compare outcomes between the collared vs non-collared designs with p 3mm was deemed clinically significant based on prior studies for similar broached stems. Both groups were comparable in sex, smoking history, diabetes, Dorr type and BMI. Patients with the collared stem had significantly fewer femur fractures compared to collarless stem designs (0/99 vs. 11/249) (p=0.043). 3 patients had intra-operative calcar cracks requiring cerclage and 8 required revision post-op. Radiographic subsidence >3 mm was also significantly lower in the collared stem group (p < 0.001) at 6 months. No statistically significant differences were observed in infection (p=0.55), hematoma formation (p=0.10), or wound complications (p=0.47). The use of collared cementless femoral stems in DAA THA resulted in significant reduction in periprosthetic femur fractures and subsidence compared to collarless stems. This was likely due to the collar acting as an intraoperative and post-operative calcar stop against over-advancement in the canal. There were no cases of early loosening with any of the stems. A prospective multi-surgeon study comparing collared and collarless versions of the Avenir-complete stem would yield stronger data. Subsidence would be more reliably measured with 3D imaging and radiostereometry. Implementing collared femoral stem designs may lead to further cost-savings and lower fracture rate in patients undergoing DAA THA.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».