Advancing the treatment of periprosthetic femoral fractures after total hip arthroplasty: A finite element analysis and experimental study
Bibliographic record
Abstract
Total hip arthroplasty (THA) is a clinically successful procedure that is broadly divided into two main categories: cemented and uncemented. Factors such as stem malalignment and poor bone quality has been associated with poor long-term outcomes and increased complications such as periprosthetic femoral fractures (PFF). Our understanding of the impact of these factors in cemented and uncemented THA and on subsequent PFF fixation (PFFx) is still limited, and not well biomechanically understood. \nThus, the use of cemented vs uncemented stem implantation in THA and subsequent management of PFF is heavily debated. Treatment for Vancouver type B1 PFF often involves fixation via a fracture plate. Fixation failure due to hardware failure (such as plate breakage) vary widely (5%-43%), often with severe consequences such as higher risk of mortality. \nThe overall aim of this thesis was to advance our fundamental understanding of treatment pathways for PFFs and their long-term management. The specific aims were: \n1.\tTo investigate the effect of stem fixation method, stem positioning, and compromised bone stock in THA. \n2.\tTo understand the biomechanical effect of cemented and uncemented THA on the fracture fixation of periprosthetic femoral fractures. \n3.\tTo develop a novel fracture fixation plate for PFF to address the current problems seen in clinical settings. \nResults demonstrated a biomechanical difference between cemented and uncemented THA, and subsequent PFF fixation. Computational models demonstrated a good agreement with experimental data. The manufactured novel fracture plate showed promising initial results, however, requires more rigorous in vitro testing before being considered for market. The modelling approach and the models that were developed and validated here can be used to further our understanding into the biomechanical behaviour of different stem fixation scenarios, its influence on the occurrence of periprosthetic fractures, and subsequent fixation.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".