Author Reply: Cement-In-Cement Revision for Selected Vancouver Type B1 Femoral Periprosthetic Fractures: A Biomechanical Analysis

Crawford, Ross; Whitehouse, Sarah L.; Brew, Chris J.; Wilson, Lance J.; Hubble, M

doi:10.1016/j.arth.2013.05.021

Cited by 4 publications

(1 citation statement)

References 4 publications

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“…Cement-in-cement stem revision techniques can be successfully utilised providing that the cement-bone interface remains intact. 32,33 Interestingly, internal fixation is also shown to be a successful treatment option providing stable anatomic reconstruction of the fracture and cement mantle can be achieved (Figure 1). 34,35 These reports highlight the variation in practice in both diagnosing and treating type B fractures around PTS stems.…”

Section: Discussionmentioning

confidence: 99%

Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems

Jain

Mohrir

Townsend³

et al. 2021

The Bone & Joint Journal

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Aims This aim of this study was to assess the reliability and validity of the Unified Classification System (UCS) for postoperative periprosthetic femoral fractures (PFFs) around cemented polished taper-slip (PTS) stems. Methods Radiographs of 71 patients with a PFF admitted consecutively at two centres between 25 February 2012 and 19 May 2020 were collated by an independent investigator. Six observers (three hip consultants and three trainees) were familiarized with the UCS. Each PFF was classified on two separate occasions, with a mean time between assessments of 22.7 days (16 to 29). Interobserver reliability for more than two observers was assessed using percentage agreement and Fleiss’ kappa statistic. Intraobserver reliability between two observers was calculated with Cohen kappa statistic. Validity was tested on surgically managed UCS type B PFFs where stem stability was documented in operation notes (n = 50). Validity was assessed using percentage agreement and Cohen kappa statistic between radiological assessment and intraoperative findings. Kappa statistics were interpreted using Landis and Koch criteria. All six observers were blinded to operation notes and postoperative radiographs. Results Interobserver reliability percentage agreement was 58.5% and the overall kappa value was 0.442 (moderate agreement). Lowest kappa values were seen for type B fractures (0.095 to 0.360). The mean intraobserver reliability kappa value was 0.672 (0.447 to 0.867), indicating substantial agreement. Validity percentage agreement was 65.7% and the mean kappa value was 0.300 (0.160 to 0.4400) indicating only fair agreement. Conclusion This study demonstrates that the UCS is unsatisfactory for the classification of PFFs around PTS stems, and that it has considerably lower reliability and validity than previously described for other stem types. Radiological PTS stem loosening in the presence of PFF is poorly defined and formal intraoperative testing of stem stability is recommended. Cite this article: Bone Joint J 2021;103-B(8):1339–1344.

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Section: Discussionmentioning

confidence: 99%

Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems

Jain

Mohrir

Townsend³

et al. 2021

The Bone & Joint Journal

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Can larger-bodied cemented femoral components reduce periprosthetic fractures? A biomechanical study

Ginsel

Morishima

Wilson

et al. 2015

Arch Orthop Trauma Surg

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Periprosthetic Fracture Torque for Short Versus Standard Cemented Hip Stems: An Experimental In Vitro Study

Morishima

Ginsel

Choy

et al. 2014

The Journal of Arthroplasty

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In an attempt to preserve proximal femoral bone stock and achieve a better fit in smaller femora, especially in the Asian population, several new shorter stem designs have become available. We investigated the torque to periprosthetic femoral fracture of the Exeter short stem compared with the conventional length Exeter stem in a Sawbone model. Forty-two stems; 21 shorter and 21 conventional stems both with three different offsets were cemented in a composite Sawbone model and torqued to fracture. Results showed that Sawbone femurs break at a statistically significantly lower torque to failure with a shorter compared to conventional-length Exeter stem of the same offset. Both standard and short-stem designs are safe to use as the torque to failure is 7-10 times that seen in activities of daily living.

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Author Reply: Cement-In-Cement Revision for Selected Vancouver Type B1 Femoral Periprosthetic Fractures: A Biomechanical Analysis

Cited by 4 publications

References 4 publications

Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems

Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems

Can larger-bodied cemented femoral components reduce periprosthetic fractures? A biomechanical study

Periprosthetic Fracture Torque for Short Versus Standard Cemented Hip Stems: An Experimental In Vitro Study

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