Wang, Katherine;
(2022)
Advancing the treatment of periprosthetic femoral fractures after total hip arthroplasty: A finite element analysis and experimental study.
Doctoral thesis (Ph.D), UCL (University College London).
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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. Thus, 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. The 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: 1. To investigate the effect of stem fixation method, stem positioning, and compromised bone stock in THA. 2. To understand the biomechanical effect of cemented and uncemented THA on the fracture fixation of periprosthetic femoral fractures. 3. To develop a novel fracture fixation plate for PFF to address the current problems seen in clinical settings. Results 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.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Advancing the treatment of periprosthetic femoral fractures after total hip arthroplasty: A finite element analysis and experimental study |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| Keywords: | Finite Element Analysis, Computational Modelling, Experimental Study, Total Hip Arthroplasty, Periprosthetic Femoral Fracture, Periprosthetic Femoral Fracture Fixation, Medical Devices Design and Development, Biomechanics, Orthopaedics |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education UCL > Provost and Vice Provost Offices > School of Education |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10154639 |
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