Acetabular defects in revision hip arthroplasty: a therapy-oriented classification.

Autor: Wirtz DC; Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127, Bonn, Germany., Jaenisch M; Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127, Bonn, Germany. max.jaenisch@ukb.uni-bonn.de., Osterhaus TA; Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127, Bonn, Germany., Gathen M; Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127, Bonn, Germany., Wimmer M; Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127, Bonn, Germany., Randau TM; Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127, Bonn, Germany., Schildberg FA; Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127, Bonn, Germany., Rössler PP; Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2020 Jun; Vol. 140 (6), pp. 815-825. Date of Electronic Publication: 2020 Feb 25.
DOI: 10.1007/s00402-020-03379-6
Abstrakt: Introduction: The treatment of severe acetabular bone loss remains a difficult challenge. No classification system is available that combines intuitive use, structured design and offers a therapeutic recommendation according to the current literature and modern state of the art treatment options. The goal of this study is to introduce an intuitive, reproducible and reliable guideline for the evaluation and treatment of acetabular defects.
Methods: The proposed Acetabular Defect Classification (ADC) is based on the integrity of the acetabular rim and supporting structures. It consists of 4 main types of defects ascending in severity and subdivisions narrowing down-defect location. Type 1 presents an intact acetabular rim, type 2 includes a noncontained defect of the acetabular rim ≤ 10 mm, in type 3 the rim defect exceeds 10 mm and type 4 includes different kinds of pelvic discontinuity. A collective of 207 preoperative radiographs were graded according to ADC and correlated with intraoperative findings. Additionally, a randomized sample of 80 patients was graded according to ADC by 5 observers to account for inter- and intra-rater reliability.
Results: We evaluated the agreement of preoperative, radiographic grading and intraoperative findings presenting with a k value of 0.74. Interobserver agreement presented with a k value of 0.62 and intraobserver at a k value of 0.78.
Conclusion: The ADC offers an intuitive, reliable and reproducible classification system. It guides the surgeon pre- and intraoperatively through a complex field of practice.
Databáze: MEDLINE
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