{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:49:05Z","timestamp":1791236945339,"version":"4.1.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T00:00:00Z","timestamp":1684454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Joint Research Project of Shanghai Municipal Pudong New Area Health Commission","award":["PW2020D-8"],"award-info":[{"award-number":["PW2020D-8"]}]},{"DOI":"10.13039\/100007219","name":"Natural Science Foundation of Shanghai","doi-asserted-by":"publisher","award":["20ZR1450000"],"award-info":[{"award-number":["20ZR1450000"]}],"id":[{"id":"10.13039\/100007219","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Taizhou City Science and Technology Program of Zhejiang","award":["21ywa18"],"award-info":[{"award-number":["21ywa18"]}]},{"name":"Science Foundation of Enze Medical Center","award":["20EZD61"],"award-info":[{"award-number":["20EZD61"]}]},{"name":"Youth Scientific Research Project of Shanghai Municipal Health Committee","award":["20204Y0478"],"award-info":[{"award-number":["20204Y0478"]}]},{"name":"the Featured Clinical Discipline Project of Shanghai, Pudong New District","award":["Pwyts2021-3"],"award-info":[{"award-number":["Pwyts2021-3"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Periprosthetic fractures (PPFs) is one of the major causes of failure of hip arthroplasty with cementless stem; however, studies on the incidence and risk factors of PPFs after cementless hemiarthroplasty for femoral neck fractures (FNFs) are lacking.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This retrospective study included patients who underwent cementless bipolar hemiarthroplasty for displaced intracapsular FNFs. The demographic data were reviewed, Dorr classification was used to describe morphology of the femur, radiological parameters were measured including stem-shaft angle, canal fill ratio (CFR), canal flare index (CFI), morphologic cortical index (MCI), canal calcar ratio (CCR), and vertical and horizontal femoral offset.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The sample comprised 10 men and 46 women (affected hip: left, 38; right, 18). The mean patient age was 82.82\u00b110.61 (range, 69\u201393) years, and the mean hemiarthroplasty to PPFs time was 26.28\u00b114.04 (range, 6.54\u201347.77) months. Seven (12.28%) patients had PPFs. A significant relationship was found between the incidence of PPF and CFR (p = 0.012), patients had a significantly smaller femoral stem CFR (0.76%\u00b10.11%) than controls (0.85%\u00b10.09%). The PPFs group had a significant shorter and unreestablished vertical femoral offset (p = 0.048).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A smaller femoral stem CFR associated with a potentially unacceptably high PPFs risk in uncemented hemiarthroplasty for displaced FNFs may result from mismatched prosthesis and bone dimensions in the elderly population, especially when accompanied by a poorly reestablished vertical femoral offset. With increasing evidence of the benefits of cemented fixation, a cemented stem for the treatment of displaced intracapsular FNFs is recommended for such a elderly frail population.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0285789","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T17:35:30Z","timestamp":1684517730000},"page":"e0285789","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["A lower canal fill rate and unreestablished vertical femoral offset may increase the risk of the postoperative periprosthetic fractures after cementless bipolar hemiarthroplasty for femoral neck fractures in elderly patients"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6123-9600","authenticated-orcid":true,"given":"Xiaoxiao","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houlin","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajun","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haixiao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,19]]},"reference":[{"issue":"8","key":"pone.0285789.ref001","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1302\/0301-620X.94B8.29155","article-title":"More re-operations after uncemented than cemented hemiarthroplasty used in the treatment of displaced fractures of the femoral neck: an observational study of 11,116 hemiarthroplasties from a national register","volume":"94","author":"JE Gjertsen","year":"2012","journal-title":"J Bone Joint Surg Br"},{"issue":"6","key":"pone.0285789.ref002","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1056\/NEJMoa2108337","article-title":"Cemented or Uncemented Hemiarthroplasty for Intracapsular Hip Fracture","volume":"386","author":"MA Fernandez","year":"2022","journal-title":"The New England journal of medicine"},{"issue":"10","key":"pone.0285789.ref003","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1016\/j.arth.2015.04.038","article-title":"Periprosthetic Fractures: A Common Problem with a Disproportionately High Impact on Healthcare Resources.","volume":"30","author":"PA Toogood","year":"2015","journal-title":"J Arthroplasty."},{"issue":"12","key":"pone.0285789.ref004","doi-asserted-by":"crossref","first-page":"2658","DOI":"10.2106\/JBJS.F.01538","article-title":"2nd, Malchau H. Mortality after periprosthetic fracture of the femur","volume":"89","author":"T Bhattacharyya","year":"2007","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"pone.0285789.ref005","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.2106\/00004623-200606000-00007","article-title":"Three hundred and twenty-one periprosthetic femoral fractures","volume":"88","author":"H Lindahl","year":"2006","journal-title":"J Bone Joint Surg Am"},{"issue":"9","key":"pone.0285789.ref006","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1007\/s00264-015-2721-y","article-title":"Incidence and predisposing factors of periprosthetic proximal femoral fractures: a literature review.","volume":"39","author":"CC Sidler-Maier","year":"2015","journal-title":"Int Orthop."},{"issue":"6","key":"pone.0285789.ref007","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.injury.2007.02.048","article-title":"Epidemiology of periprosthetic femur fracture around a total hip arthroplasty.","volume":"38","author":"H. 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Jamsen","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"pone.0285789.ref017","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1302\/0301-620X.93B1.25087","article-title":"The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement.","volume":"93","author":"RM Meek","year":"2011","journal-title":"The Journal of bone and joint surgery British volume"},{"issue":"6","key":"pone.0285789.ref018","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1016\/j.arth.2015.12.030","article-title":"Incidence and Risk Period of Periprosthetic Femoral Fracture After Cementless Bipolar Hemiarthroplasty in Elderly Patients.","volume":"31","author":"B-H Yoon","year":"2016","journal-title":"The Journal of Arthroplasty"},{"issue":"7","key":"pone.0285789.ref019","first-page":"1801","article-title":"Initial femoral stem position in cementless bipolar hemiarthroplasty for femoral neck fracture in elderly patients is associated with 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