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A New Classification System for Acetabular Bone Defect Evaluation in Posttraumatic Acetabular Nonunion and Malunion

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Abstract

Introduction

There is no distinct classification system to evaluate the bone defect in previously managed acetabular fractures. We propose a new classification system for bone defect evaluation in a previously managed acetabular fracture that will be helpful for total hip arthroplasty (THA).

Materials and Methods

The preoperative pelvis radiographs of 99 THA patients with previous acetabular fractures with at least 2 years of follow-up were evaluated by 10 experienced surgeons (Paprosky and new classification systems). As per the new classification system, the five types of bone defects are circumferential, posterior wall, posterior column, both column defect, and anterior column. The interobserver and intraobserver reliability was calculated, and a consensus management plan based on the recommendation of the observers was formulated.

Results

There was fair interobserver reliability for Paprosky classification (alpha coefficient 0.39) and substantial interobserver reliability for the new classification (alpha co-efficient 0.71). There was a substantial intraobserver agreement for the new classification (kappa value 0.80) and moderate intraobserver agreement for Paprosky classification (kappa value 0.55). Sixty-nine patients who were treated as per the management plan of the observers reported significant improvement in modified Harris hip score (improved from 25 to 85.88, p < 0.001). 89.7% of patients reported good to excellent outcomes. Overall best health as per EQ-5D VAS was obtained in THA following anterior column fracture (EQ-5D VAS 97.5), and relatively poor health was obtained after THA of posterior column nonunion (EQ-FD VAS 80).

Conclusions

 The new classification system for bone defect evaluation in previously treated acetabular fractures is valid and reliable. The proposed surgical plan for the management of bone defects in THA provided good to excellent outcomes.

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Availability of Data and Material

The data of the study are available to share. The data will be shared on request. This presentation was presented by DR Ramesh Sen in AO trauma masters course and European pelvis expert group.

Materials and/or Code Availability

Available on request.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Institute of Orthopaedics, Max Hospital Mohali, Punjab, 160055, India

    Ramesh K. Sen, Reet Mukhopadhyay, Veeresh Pattanshetti & Gaurav Saini

  2. Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India

    Sujit Kumar Tripathy & Siddharth Sekhar Sethy

  3. Department of Statistics and Ex-Coordinator, Centre for Systems Biology and Bioinformatics, Panjab University, Chandigarh, 160014, India

    Suresh Kumar Sharma

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  1. Ramesh K. Sen
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Contributions

SKT, RKS, RM and SKS designed the study. RM and GS collected the data. RM, and SKS analysed the data. The draft was prepared by SKT and RM. All authors read the manuscript and approved it for publication.

Corresponding author

Correspondence to Sujit Kumar Tripathy.

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The authors of this manuscript declare that they have no conflicts of interest to disclose.

Ethical Approval

We certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards been approved by the Max Hospital ethics committee, Mohali, Chandigarh.

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Informed consent was obtained from all individual participants included in the study.

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Consent was obtained from all participants before recruitment into the study.

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Sen, R.K., Mukhopadhyay, R., Pattanshetti, V. et al. A New Classification System for Acetabular Bone Defect Evaluation in Posttraumatic Acetabular Nonunion and Malunion. JOIO 56, 1601–1612 (2022). https://doi.org/10.1007/s43465-022-00677-6

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