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Background 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. Methods Twenty-two cadaveric femora (11 matched pairs) with a mean age of 77 ± 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. Results 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 -1.95 (range, -4.1 to -0.15). 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. Conclusions Collared stems seemed to offer a protective effect in torsional loading in this biomechanical model comparing matched femora. Clinical relevance These results may translate into a protective effect against early periprosthetic Vancouver B2 femoral fractures that occur before osseous integration has occurred.

The main ideology behind developing this system is to avail the distributors to do their daily task such as Accounting, Stock Maintenance, and Billing at a single point. The current situation in the market is Distributors are using different software to manage their work, for e.g. Billing is done by one software and Accounting is done by other software. They have to learn and manage two different software to complete his/her work and even there is no compatibility between those softwares. Some kind of same details may need to be entered more than once which is a tedious job. Now, our cloud based ERP system will help various distributors to manage their work smoothly. The various distributors can use the same ERP and as the whole system would be deployed on Cloud, different user's data will not interfere with each other.

This paper describes a study to investigate future demand from older people for social care services in Hampshire, UK. The study used system dynamics to explore the significant challenges of an ageing population in the context of budget limitations. The results show that as anticipated, the numbers requiring care will increase considerably over the next 5 years. The effects of two possible interventions to reduce the impact of this are explored.