Collared fully hydroxyapatite-coated femoral components reduce early periprosthetic femoral fractures in total hip arthroplasty with the direct anterior approach
Bibliographic record
Abstract
Aims: The purpose of this study was to investigate the difference in the incidence of early postoperative periprosthetic femoral fracture (POPFF) between flat-tapered wedge and collared fully hydroxyapatite (HA)-coated femoral components performed through the direct anterior approach (DAA). Methods: This was a retrospective comparative study of 4,511 primary total hip arthroplasties (THAs), including 1,842 flat-tapered wedge and 2,669 collared fully HA-coated components, conducted by a single surgeon at a single institution using the DAA from August 2009 to June 2023. Propensity score matching was used to control confounding factors related to POPFF. After matching, 1,804 cases were selected for each group, and the incidence of early POPFF was compared between the two implant designs. An early POPFF was defined as a periprosthetic fracture undetected intraoperatively and on immediate postoperative radiographs that occurred within 90 days. The incidence of intraoperative periprosthetic femoral fracture (IOPFF) was also evaluated and compared between the two groups. Results: Early POPFF was significantly less frequent in the collared fully HA-coated designs (0.11%; n = 2) than in the flat-tapered wedge designs (0.72%; n = 13; p = 0.007). Regarding the details of early POPFFs, the median time to fracture was ten days and an injury mechanism was absent in 73% (n = 11). According to the Vancouver classification, two were fracture type A(G) and one was A(L), while B1 and B2 fractures comprised 33% (n = 5) and 47% (n = 7), respectively. Treatment methods included conservative management in 33% (n = 5), osteosynthesis in 53% (n = 8), and revision surgery in 13% (n = 2). IOPFF was significantly more frequent in the collared fully HA-coated designs (3.49%; n = 63) than in the flat-tapered wedge designs (2.00%; n = 36; p = 0.008). Conclusion: The results of this large-scale, propensity score-matched study implied that the incidence of early POPFFs with collared fully HA-coated femoral components was lower than flat-tapered wedge designs. However, the incidence of IOPFFs was higher with collared fully HA-coated femoral components. These findings highlight the importance of femoral component design, including broaching, in THA implant selection for POPFF and IOPFF.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| 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) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".