THE INCIDENCE OF LATE PERIPROSTHETIC FEMORAL FRACTURES BY IMPLANT TYPE: A SYSTEMATIC REVIEW
Bibliographic record
Abstract
Periprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) is the leading cause of reoperation when revision and open reduction internal fixation are considered together. With morbidity and mortality similar to hip fractures, prevention is paramount. A growing body of evidence has identified polished taper slip (PTS) cemented designs as high risk and collars as protective in cementless designs. The fracture risk of other cementation philosophies is less clear, and how cementless designs compare when intra and early postoperative fractures are excluded. We compared the incidence of late PFFs following THA across all stem types that occurred at a minimum of three months postoperatively. We conducted a systematic review of studies, written in English and published in peer-reviewed journals since the year 2000. The Newcastle-Ottawa scale was utilised to assess study quality. The overall study qualities were good. 28,854 hips from 28 articles were included in the systematic review. 19,552 were cemented and 9,302 were cementless. We classified stems into subtypes to compare similar designs. Articles were excluded if intraoperative and fractures within three months could not be removed. French paradox cemented stems had the lowest fracture risk when data was pooled, and an incidence per 100 years was calculated (2/974, 0.03% per 100 years). PTS stems had the highest risk (191/17235, 1.1%), ahead of composite beam (CB) stems (2/1343, 0.1%). Within PTS, CPT (9/386, 0.55%) and C Stems (12/583, 0.37%) had over triple the fracture risk of the ExeterV40 (68/6979, 0.10%). The overall fracture rate of cementless stems was 0.8% regardless of stem design (72/9302), compared to 1% in cemented (195/19522). There is a paucity of studies comparing the late PFF risk of different successfully implanted stems designs. The late PPF risk of cementless stems is lower than that of cemented stems. French Paradox and CB stems had lower late PPF risk than PTS, though fewer data are available describing their use. Reducing the rising burden of PFFs globally will be multifaceted, however, selecting implants with protective design features will form a cornerstone of any approach.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".