Clinical Orthopaedics and Related Research®

, Volume 471, Issue 7, pp 2259–2265 | Cite as

Validity and Reliability of the Paprosky Acetabular Defect Classification

  • Raymond Yu
  • Jochen G. Hofstaetter
  • Thomas Sullivan
  • Kerry Costi
  • Donald W. Howie
  • Lucian B. Solomon
Clinical Research



The Paprosky acetabular defect classification is widely used but has not been appropriately validated. Reliability of the Paprosky system has not been evaluated in combination with standardized techniques of measurement and scoring.


This study evaluated the reliability, teachability, and validity of the Paprosky acetabular defect classification.


Preoperative radiographs from a random sample of 83 patients undergoing 85 acetabular revisions were classified by four observers, and their classifications were compared with quantitative intraoperative measurements. Teachability of the classification scheme was tested by dividing the four observers into two groups. The observers in Group 1 underwent three teaching sessions; those in Group 2 underwent one session and the influence of teaching on the accuracy of their classifications was ascertained.


Radiographic evaluation showed statistically significant relationships with intraoperative measurements of anterior, medial, and superior acetabular defect sizes. Interobserver reliability improved substantially after teaching and did not improve without it. The weighted kappa coefficient went from 0.56 at Occasion 1 to 0.79 after three teaching sessions in Group 1 observers, and from 0.49 to 0.65 after one teaching session in Group 2 observers.


The Paprosky system is valid and shows good reliability when combined with standardized definitions of radiographic landmarks and a structured analysis.

Level of Evidence

Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.


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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Raymond Yu
    • 1
  • Jochen G. Hofstaetter
    • 1
    • 2
    • 3
  • Thomas Sullivan
    • 4
  • Kerry Costi
    • 1
  • Donald W. Howie
    • 1
    • 2
  • Lucian B. Solomon
    • 1
    • 2
  1. 1.Orthopaedic & Trauma Service, Department of Orthopaedic & TraumaRoyal Adelaide HospitalAdelaideAustralia
  2. 2.Centre for Orthopaedic and Trauma ResearchUniversity of AdelaideAdelaideAustralia
  3. 3.Department of OrthopaedicsVienna General Hospital, Medical University of ViennaViennaAustria
  4. 4.Discipline of Public HealthUniversity of AdelaideAdelaideAustralia

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