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Advanced quantitative 3D imaging improves the reliability of the classification of acetabular defects

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Classifying complex acetabular defects in revision total hip arthroplasty (THA) by means of conventional radiographs comes with significant limitations. Statistical shape modelling allows the virtual reconstruction of the native pelvic morphology, hereby enabling an analytic acetabular defect assessment. Our objective was to evaluate the effect of advanced imaging augmented with analytic representations of the defect on (1) intra- and inter-rater reliability, and (2) up- or downscaling of classification scores when evaluating acetabular defects in patients undergoing revision THA.

Materials and methods

The acetabular defects of 50 patients undergoing revision THA were evaluated by three independent, fellowship-trained orthopaedic surgeons. Defects were classified according to the acetabular defect classification (ADC) using four different imaging-based representations, namely, standard radiographs, CT imaging, a virtual three-dimensional (3D) model and a quantitative analytic representation of the defect based on a statistical shape model reconstruction. Intra- and inter-rater reliabilities were quantified using Fleiss’ and Cohen’s kappa scores, respectively. Up- and downscaling of classification scores were compared for each of the imaging-based representations and differences were tested.

Results

Overall inter-rater agreement across all imaging-based representations for the classification was fair (κ 0.29 95% CI 0.28–0.30). Inter-rater agreement was lowest for radiographs (κ 0.21 95% CI 0.19–0.22) and increased for other representations with agreement being highest when using analytic defect models (κ 0.46 95% CI 0.43–0.48). Overall intra-rater agreement was moderate (κ 0.51 95% CI 0.42–0.60). Intra-rater agreement was lowest for radiographs (κ 0.40 95% CI 0.23–0.57), and highest for ratings including analytic defect models (κ 0.64:95% CI 0.46–0.82). Virtual 3D models with quantitative analytic defect representations upscaled acetabular defect scores in comparison to standard radiographs.

Conclusions

Using 3D CT imaging with statistical shape models doubles the intra- and inter-rater reliability and results in upscaling of acetabular defect classification when compared to standard radiographs. This method of evaluating defects will aid in planning surgical reconstruction and stimulate the development of new classification systems based on advanced imaging techniques.

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Funding

The research for this paper was financially supported by the PROSPEROS project, funded by the Interreg VAFlanders—The Netherlands program, CCI Grant no. 2014TC16RFCB046; A.M. is a SB PhD fellow at FWO (Research Foundation—Flanders) Grant no. 1SB3819N.

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Authors and Affiliations

  1. Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium

    Alexander Meynen, Georges Vles, Anthony Van Eemeren, Hazem Wafa, Michiel Mulier & Lennart Scheys

  2. Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Georges Vles, Anthony Van Eemeren, Hazem Wafa, Michiel Mulier & Lennart Scheys

  3. Department of Trauma and Orthopaedics, University College Hospital London, London, NW1 2BU, UK

    Mark Roussot

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  1. Alexander Meynen
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  2. Georges Vles
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  4. Anthony Van Eemeren
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  7. Lennart Scheys
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Contributions

AM contributed to the image segmentation, development of the modeling approach, study design, data analysis, manuscript writing and preparation. GV contributed to the study design, data generation, manuscript writing and preparation. MR, AVE and HW contributed to the data generation, manuscript writing and preparation. MM supervised the research, contributed to the image segmentation, manuscript writing and preparation. LS supervised the research, contributed to the development of the modeling approach, study design, manuscript writing and preparation. All authors have read and approved the final submitted manuscript.

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Correspondence to Alexander Meynen.

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Meynen, A., Vles, G., Roussot, M. et al. Advanced quantitative 3D imaging improves the reliability of the classification of acetabular defects. Arch Orthop Trauma Surg 143, 1611–1617 (2023). https://doi.org/10.1007/s00402-022-04372-x

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