{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:06:23Z","timestamp":1792476383670,"version":"4.5.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,19]]},"abstract":"\n Background:<\/jats:title>\n Periprosthetic fracture is a leading reason for readmission following total hip arthroplasty. Most of these fractures occur during the early postoperative period before bone ingrowth. Before ingrowth occurs, the femoral component can rotate relative to the femoral canal, causing a spiral fracture pattern. We sought to evaluate, in a paired cadaver model, whether the torsional load to fracture was higher in collared stems. The hypothesis was that collared stems have greater load to fracture under axial and torsional loads compared with collarless stems.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Twenty-two cadaveric femora (11 matched pairs) with a mean age of 77 \u00b1 10.2 years (range, 54 to 90 years) were harvested. Following dissection, the femora were evaluated with use of a dual x-ray absorptiometry scanner and T scores were recorded. We utilized a common stem that is available with the same intraosseous geometry with and without a collar. For each pair, 1 femur was implanted with a collared stem and the contralateral femur was implanted with a collarless stem with use of a standard broaching technique. A compressive 68-kg load was applied to simulate body weight during ambulation. A rotational displacement was then applied until fracture occurred. Peak torque prior to fracture was measured with use of a torque meter load cell and data acquisition software.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n The median torque to fracture was 65.4 Nm for collared stems and 43.1 Nm for uncollared stems (p = 0.0014, Wilcoxon signed-rank test). The median T score was \u20131.95 (range, \u20134.1 to \u20130.15). The median difference in torque to fracture was 29.18 Nm. As expected in each case, the mode of failure was a spiral fracture around the implant.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n Collared stems seemed to offer a protective effect in torsional loading in this biomechanical model comparing matched femora.<\/jats:p>\n <\/jats:sec>\n \n Clinical Relevance:<\/jats:title>\n These results may translate into a protective effect against early periprosthetic Vancouver B2 femoral fractures that occur before osseous integration has occurred.<\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.19.01125","type":"journal-article","created":{"date-parts":[[2020,4,23]],"date-time":"2020-04-23T04:12:42Z","timestamp":1587615162000},"page":"1427-1433","source":"Crossref","is-referenced-by-count":69,"title":["A Calcar Collar Is Protective Against Early Torsional\/Spiral Periprosthetic Femoral Fracture"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0764-1455","authenticated-orcid":false,"given":"Aaron J.","family":"Johnson","sequence":"first","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7193-1342","authenticated-orcid":false,"given":"Shivam","family":"Desai","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6794-5760","authenticated-orcid":false,"given":"Chunyang","family":"Zhang","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3481-4152","authenticated-orcid":false,"given":"Kyung","family":"Koh","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5882-7965","authenticated-orcid":false,"given":"Li-Qun","family":"Zhang","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland"},{"name":"Department of Bioengineering, University of Maryland School of Engineering, College Park, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4207-6356","authenticated-orcid":false,"given":"Timothy","family":"Costales","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5628-6584","authenticated-orcid":false,"given":"Robert V.","family":"O\u2019Toole","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5316-8892","authenticated-orcid":false,"given":"Theodore T.","family":"Manson","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics (A.J.J., S.D., L.-Q.Z., T.C., R.V.O., and T.T.M), and the Department of Physical Therapy and Rehabilitation Science (C.Z., K.K., and L.-Q.Z.), University of Maryland Medical System, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,4,21]]},"reference":[{"issue":"9","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.2106\/JBJS.H.00331","article-title":"Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management","volume":"90","author":"Davidson","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"11","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1016\/j.arth.2015.05.044","article-title":"Early postoperative femur fracture after uncemented collarless primary total hip arthroplasty: characterization and results of treatment","volume":"30","author":"Taunton","year":"2015","journal-title":"J Arthroplasty."},{"issue":"7S","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"S352","DOI":"10.1016\/j.arth.2019.02.004","article-title":"Perioperative periprosthetic femur fractures are strongly correlated with fixation method: an analysis from the American Joint Replacement Registry","volume":"34","author":"Springer","year":"2019","journal-title":"J Arthroplasty."},{"issue":"10","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1302\/0301-620X.101B10.BJJ-2018-1596.R1","article-title":"Patient and implant survival following intraoperative periprosthetic femoral fractures during primary total hip arthroplasty: an analysis from the national joint registry for England, Wales, Northern Ireland and the Isle of Man","volume":"101-B","author":"Lamb","year":"2019","journal-title":"Bone Joint J."},{"issue":"4","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1302\/0301-620X.98B4.37201","article-title":"Epidemiology of periprosthetic fracture of the femur in 32 644 primary total hip arthroplasties: a 40-year experience","volume":"98-B","author":"Abdel","year":"2016","journal-title":"Bone Joint J."},{"key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/00003086-199606000-00029","article-title":"Periprosthetic fractures of the femur. An analysis of 93 fractures","volume":"327","author":"Beals","year":"1996","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s00402-015-2172-3","article-title":"Can larger-bodied cemented femoral components reduce periprosthetic fractures? 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A bilateral comparative cadaver study","volume":"26","author":"Demey","year":"2011","journal-title":"J Arthroplasty."},{"issue":"4","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1302\/0301-620X.85B4.12843","article-title":"The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus","volume":"85","author":"Tingart","year":"2003","journal-title":"J Bone Joint Surg Br."},{"issue":"2","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1002\/jor.22994","article-title":"Radiographic morphometry and densitometry predict strength of cadaveric proximal humeri more reliably than age and DXA scan density","volume":"34","author":"Skedros","year":"2016","journal-title":"J Orthop Res."},{"issue":"8","key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1097\/01.bot.0000245684.96775.82","article-title":"Comparison of lateral locking plate and antiglide plate 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cemented, tapered, polished stem","volume":"86","author":"Brod\u00e9n","year":"2015","journal-title":"Acta Orthop."},{"issue":"19","key":"bib23-20230810","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.2106\/JBJS.M.00643","article-title":"Periprosthetic femoral fracture within two years after total hip replacement: analysis of 437,629 operations in the Nordic Arthroplasty Register Association database","volume":"96","author":"Thien","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib24-20230810","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1302\/0301-620X.100B12.BJJ-2018-0262.R1","article-title":"More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures: a study from the Norwegian Hip Fracture Register 2005 to 2016","volume":"100-B","author":"Kristensen","year":"2018","journal-title":"Bone Joint 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Biomech."},{"issue":"1","key":"bib28-20230810","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s00423-003-0434-y","article-title":"Hip joint contact forces during stumbling","volume":"389","author":"Bergmann","year":"2004","journal-title":"Langenbecks Arch Surg."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.01125","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:40:59Z","timestamp":1787751659000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.01125"}},"subtitle":["A Paired Cadaveric Biomechanical Analysis"],"short-title":[],"issued":{"date-parts":[[2020,4,21]]},"references-count":28,"journal-issue":{"issue":"16","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.19.01125","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,21]]}}}