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Reliability and Validity of Acetabular and Femoral Bone Loss Classification Systems in Total Hip Arthroplasty: A Systematic Review

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HSS Journal ®

Abstract

Background

A variety of classification systems have been developed to help surgeons treat patients with acetabular or femoral bone loss in total hip arthroplasty, yet no “gold standard” for classification has been agreed upon. Furthermore, the reliability and validity of the available classification systems remain unknown.

Questions/Purpose

The aims of our study were to determine the reliability and validity of the three most common acetabular and femoral bone loss classification systems (Paprosky, American Academy of Orthopaedic Surgeons [AAOS], and Saleh and Gross).

Methods

A systematic review of the literature was performed to identify studies that reported on the reliability or validity (or both) of the acetabular and femoral components of the three bone loss classification systems.

Results

In all, seven articles met our inclusion criteria. Six studies reported on the reliability (all six studies) or validity (three studies) of acetabular bone loss rating systems (286 acetabula), and five analyzed reliability (all five studies) or validity (three studies) of femoral bone loss classification systems (364 femurs). In studies in which either the Paprosky or AAOS acetabular bone loss classifications were used, the classification systems were considered unreliable in 75% and 100% of them, respectively. On the femoral side, the Paprosky classification demonstrated moderate interobserver and good intraobserver reliability. The AAOS femoral bone classification was found to have good intraobserver reliability but poor interobserver reliability. The Saleh and Gross acetabular and femoral bone loss classification systems yielded mixed results, but each was considered reliable in one of the studies looking at these aspects of the systems.

Conclusion

Although surgical techniques, treatment options, and advanced imaging available to the surgeon have evolved over the past few decades, the acetabular and femoral bone loss classification systems, first developed in the 1990s, have remained largely unchanged. Our results indicate that improvements to these systems are necessary in order for them to be as useful as possible in planning the surgical course.

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References

  1. Anagnostakos K, Schmid NV, Kelm J, Grün U, Jung J. Classification of hip joint infections. Int J Med Sci. 2009;6(5):227–233.

    Article  Google Scholar 

  2. Brown NM, Foran JR, Valle CJ, et al. The inter-observer and intra-observer reliability of the Paprosky femoral bone loss classification system. J Arthroplasty. 2014;29(7):1482–1484.

    Article  Google Scholar 

  3. Callaghan JJ. The Adult Knee. Lippincott Williams and Wilkins. 2003.

  4. Campbell DG, Garbuz DS, Masri BA, Duncan CP. Reliability of acetabular bone defect classification systems in revision total hip arthroplasty. J Arthroplasty. 2001;16(1):83–86.

    Article  CAS  Google Scholar 

  5. D’Antonio JA. Periprosthetic bone loss of the acetabulum. Classification and management. Orthop Clin North Am. 1992;23(2):279–290.

    PubMed  Google Scholar 

  6. D’Antonio J, Capello W, Borden L, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;(243):126–137.

    Google Scholar 

  7. Davis AM, Schemitsch EH, Gollish JD, et al. Classifying failed hip arthroplasty: generalizability of reliability and validity. Clin Orthop Relat Res. 2003;(415):171–179.

    Article  Google Scholar 

  8. Della Valle CJ, Paprosky WG. The femur in revision total hip arthroplasty evaluation and classification. Clin Orthop Relat Res. 2004;(420):55–62.

    Article  Google Scholar 

  9. Fehring K, Howe B, Martin J, Taunton M, Berry D. Preoperative evaluation for pelvic discontinuity using a new reformatted computed tomography scan protocol. J Arthroplasty. 2016;31(10):2247–2251.

    Article  Google Scholar 

  10. Gozzard C, Blom A, Taylor A, Smith E, Learmonth I. A comparison of the reliability and validity of bone stock loss classification systems used for revision hip surgery. J Arthroplasty. 2003;18(5):638–642.

    Article  Google Scholar 

  11. Gross AE, Duncan CP, Garbuz D, Mohamed EM. Revision arthroplasty of the acetabulum in association with loss of bone stock. Instr Course Lect. 1999;48:57–66.

    CAS  PubMed  Google Scholar 

  12. Hettich G, Schierjott RA, Ramm H. Method for quantitative assessment of acetabular bone defects. J Orthop Res. 2019;37(1):181–189.

    Article  Google Scholar 

  13. Howick J, Chalmers I, Galsziou P, et al. Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). Oxford Centre for Evidence-Based Medicine. https://www.cebm.net/index.aspx?o=5653.

  14. Ibrahim DA, Fernando ND. Classifications in brief: the Paprosky classification of femoral bone loss. Clin Orthop Relat Res. 2017;475(3):917–921

    Article  Google Scholar 

  15. Kurtz S, Lau E, Ong K, Zhao K, Kelly M, and Bozic KJ. Future young patient demand for primary and revision joint replacement: national projection from 2010 to 2030. Clin Orthop Relat Res. 2009;467: 2606–2612.

    Article  Google Scholar 

  16. Landis JR, Koch GG. The measurement of observer agreement for categorial data. Biometrics. 1977;33(1): 159–174.

    Article  CAS  Google Scholar 

  17. Munjal S, Leopold SS, Kornreich D, Shott S, Finn HA. CT-generated 3-dimensional models for complex acetabular reconstruction. J Arthroplasty. 2000;15(5):644–653.

    Article  CAS  Google Scholar 

  18. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994;9(1):33–44.

    Article  CAS  Google Scholar 

  19. Parry MC, Whitehouse MR, Mehendale SA, et al. A comparison of the validity and reliability of established bone stock loss classification systems and the proposal of a novel classification system. Hip Int. 2010;20(1):50–55.

    Article  Google Scholar 

  20. Robertson DD, Sutherland CJ, Lopes T, Yuan J. Preoperative description of severe acetabular defects caused by failed total hip replacement. J Comput Assist Tomogr. 1998;22(3):444–449.

    Article  CAS  Google Scholar 

  21. Saleh KJ, Holtzman J, Gafni A, et al. Reliability and intraoperative validity of preoperative assessment of standardized plain radiographs in predicting bone loss at revision hip surgery. J Bone Joint Surg Am. 2001;83-A(7):1040–1046.

    Article  Google Scholar 

  22. Saleh KJ, Holtzman J, Gafni A, et al. Development, test reliability and validation of a classification for revision hip arthroplasty. J Orthop Res. 2001;19(1):50–56.

    Article  CAS  Google Scholar 

  23. Sambandam SN, Gul A, Priyanka P. Analysis of methodological deficiencies of studies reporting surgical outcome following cemented total-joint arthroplasty of trapezio-metacarpal joint of the thumb. Int Orthop. 2007;31(5):639–645.

    Article  Google Scholar 

  24. Schierjott RA, Hettich G, Graichen H, et al. Quantitative assessment of acetabular bone defects: a study of 50 computed tomography data sets. PLoS One. 2019;14(10):e0222511.

    Article  CAS  Google Scholar 

  25. Sheth NP, Nelson CL, Paprosky WG. Femoral bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2013;21(10):601–612.

    Article  Google Scholar 

  26. Sheth NP, Nelson CL, Springer BD, Fehring TK, Paprosky WG. Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 2013;21(3):128–139.

    Article  Google Scholar 

  27. Telleria JJ, Gee AO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res. 2013;471(11):3725–3730.

    Article  Google Scholar 

  28. Ulrich SD, Seyler TM, Bennett D, et al. Total hip arthroplasties: what are the reasons for revision? Int Orthop. 2008;32(5):597–604.

    Article  Google Scholar 

  29. Yu R, Hofstaetter JG, Sullivan T, Costi K, Howie DW, Solomon LB. Validity and reliability of the Paprosky acetabular defect classification. Clin Orthop Relat Res. 2013;471(7):2259–2265.

    Article  Google Scholar 

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Authors and Affiliations

  1. Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA

    Alex Gu BS, Marco Adriani MD, Michael-Alexander Malahias MD, PhD, Allina A. Nocon MPH, Mathias P. Bostrom MD & Peter K. Sculco MD

  2. Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA

    Alex Gu BS, Marco Adriani MD & Safa C. Fassihi MD

Authors
  1. Alex Gu BS
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  2. Marco Adriani MD
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  3. Michael-Alexander Malahias MD, PhD
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  4. Safa C. Fassihi MD
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  5. Allina A. Nocon MPH
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  6. Mathias P. Bostrom MD
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  7. Peter K. Sculco MD
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Corresponding author

Correspondence to Peter K. Sculco MD.

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Conflict of Interest

Alex Gu, BS, Marco Adriani, MD, Michael-Alexander Malahias, MD, PhD, Allina A. Nocon, MPH, declare that they have no conflicts of interest. Safa C. Fassihi, MD, reports receiving research support from Intellijoint Surgical and being an unpaid consultant for Lima Corporate; Mathias P. Bostrom, MD, reports receiving royalties, consulting fees, and research support from Smith and Nephew, research support from the Mandl Research Foundation and the National Institutes of Health (the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the Eunice Kennedy Shriver National Institute of Child Health and Human Development), serving on the editorial board of HSS Journal, and having board membership or committee appointments with the American Austrian Foundation and the Hip Society; Peter K. Sculco, MD, reports receiving research support from Intellijoint Surgical and being and unpaid consultant for Lima Corporate, outside the submitted work.

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Level of Evidence: Level III: Systematic Review of Level II and III Studies

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Gu, A., Adriani, M., Malahias, MA. et al. Reliability and Validity of Acetabular and Femoral Bone Loss Classification Systems in Total Hip Arthroplasty: A Systematic Review. HSS Jrnl 16, 288–295 (2020). https://doi.org/10.1007/s11420-020-09766-4

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  • DOI: https://doi.org/10.1007/s11420-020-09766-4

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