Differences between proximal bone remodeling in femoral revisions for aseptic loosening and periprosthetic fractures using the Wagner SL stem
Bibliographic record
Abstract
BACKGROUND: Monoblock taper fluted stems have been reliably used to treat proximal femoral periprosthetic fractures (PFF) and femoral aseptic loosening (AL). Although proximal femoral remodeling has been observed around the Wagner Self-Locking (SL) stem, the exact characteristics of this process are yet to be established. Our aim was to compare the remodeling that takes place after femoral revisions for PFF and AL. METHODS: Consecutive patients between January 2015 and December 2017 undergoing femoral revision using the Wagner SL stem for PFF or AL without an extended trochanteric osteotomy (ETO) or bone grafting were selected from our database. Radiological follow-up was performed using plain antero-posterior hip radiographs taken postoperatively and at 3, 6, 12 months and at 24 months. The Global Radiological Score (GRxS) was utilized by four blinded observers. Intra and interobserver variability was calculated. Secondary outcome measures included the Oxford Hip Score and the Visual Analog Scale for pain. RESULTS: We identified 20 patients from our database, 10 PFF and 10 AL cases. The severity of AL was Paprosky 2 in 2 cases, Paprosky 3A in 2 cases and Paprosky 3B in 6. PFF were classified as Vancouver B2 in 7 cases and Vancouver B3 in 3 cases. Patients undergoing femoral revision for PFF regained 89% (GRxS: 17.7/20) of their bone stock by 6 months, whilst patients with AL, required almost 2 years to achieve similar reconstitution of proximal femoral bony architecture 86% (GRxS: 17.1/20). Inter-observer reproducibility for numerical GRxS values showed a "good" correlation with 0.68, whilst the intra-observer agreement was "very good" with 0.89. Except immediate after the revision, we found a significant difference between the GRxS results of the two groups at each timepoint with pair-wise comparisons. Functional results were similar in the two groups. We were not able to show a correlation between GRxS and functional results. CONCLUSIONS: Proximal femoral bone stock reconstitutes much quicker around PFF, than in the cases of AL, where revision is performed without an ETO. The accuracy of GRxS measurements on plain radiographs showed good reproducibility, making it suitable for everyday use in a revision arthroplasty practice.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".