DOES THE USE OF TAPER-SLIP CEMENTED STEM REDUCE PERIPROSTHETIC FRACTURE RISK WITH THE ANTERIOR APPROACH? A CASE-CONTROL STUDY
Bibliographic record
Abstract
Periprosthetic fracture (PPF) risk post-THA with uncemented, short stems, is increased with the anterior approach (AA). Whether cemented stems reduce this risk is unknown. This study aims to 1. Assess whether use of a cemented stem with the AA reduces PPF-risk; and 2. Identify factors that influence outcome when using a cemented stem. This is a retrospective, consecutive, multi-surgeon, case-control study from an academic center. The first 100 hybrid THAs (cases) with a taper-slip cemented stem, inserted with the AA were studied (69% females; age:74±10 years-old; BMI:26±5). Controls comprised of 200 uncemented THAs with a short, uncemented stem, performed by the same arthroplasty surgeons, prior to introduction of the cemented stem. Cases and controls were matched for patient factors known to influence fracture risk: age, gender, BMI, diagnosis, femoral- (DORR-type; canal-flare index) and pelvic- (ilioischial ratio, ASIS-GT distance) morphologies. Outcomes of interest included: PPF-risk, stem subsidence, quality of cementation (optimum: Barrack-cementation grades: A/B or suboptimum: Barrack-cementation grades: C/D). At minimum 1-year follow-up, there were 11 PPFs (3.6%). There was no difference in PPF-risk between cemented (4/100; 2xVancouver-A; 2xVancouver-B2) and uncemented stems (7/200; 1xVancouver-A; 1xVancouver-B1; 5xVancouver-B2) (p=0.9). Suboptimum cementation was seen in 15 hips (15%); two of which fractured (Vancouver-B2; risk-ratio:27; p=0.03) and one subsided. Hips with suboptimum cementation had lower ASIS-GT distance (88±15 vs. 101±15; p=0.004); lower canal-flare-index (3.2±0.5 vs. 3.7±0.7; p=0.015) and higher canal-calcar-ratio (0.54±0.08 vs. 0.47±0.08; p=0.005) compared to optimally cemented hips. Use of a taper-slip cemented stem is not associated with reduced PPF risk following AA-THA. Vancouver B2 and subsidence were only seen with suboptimal cementation. Suboptimum cementation was associated the narrow operative window (short ASIS-GT distance), which reduces the ability to adequately insert and pressurize cement, especially in capacious femurs, using current equipment (rigid/long) that do not favor cementation with the AA.
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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 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 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".