Component migration is usually superomedially. Paprosky developed the classification evaluating patients. Acetabular defects were graded pre- operatively. Acetabular and Femoral Defect Classification* Acetabular Revision System . Paprosky W, Perona P, Lawrence J. Acetabular defect classification and. One commonly used classification is the Paprosky classification for femoral bone Type I femoral bone loss refers to a defect in which minimal . to more complex anatomic structures such as the acetabulum, the limitations of.
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Results of cementless revision for failed cemented total hip arthroplasty. Trabecular metal used for major bone loss in acetabular hip revision.
Reliability of acetabular bone defect classification systems in revision total hip arthroplasty. She is unable to weight bear on the left leg, but denies any other pain or systemic symptoms. Other fundamental differences include the presence or absence of standard anatomic landmarks compared with pure volumetric bone loss independent of the structures affected and the focus on bone stock remaining in contrast to bone stock required for revision [ 7 ].
Angiography Angiography or CT angiography to identify the major pelvic arteries may be indicated in certain cases. Defects are classified as types I-III. The main goals of acetabular revision are 1 to extract failed implants with minimal bone and soft tissue damage, 2 to implant new components that provide long-term pain relief and good function, and 3 to manage bone deficiencies effectively and if possible restore bone stock.
Acetabular Reconstruction: Classification of Bone Defects and Treatment Options
Validity and reliability of the Paprosky acetabular defect classification. With medial migration of the acetabular component the line becomes obscured and the disruption may not be appreciated.
J Am Acad Orthop Surg.
Good outcome in 43 patients followed for a mean of 2 years. This should be pursued while minimising morbidity and cost. It is however technically difficult and high complication and failure rates have been reported. One study compared the Paprosky classification with other classification systems [ 12 ].
Given the complexity of revision THA, the Paprosky system identifies which acetabular supporting structures are deficient for the refects of predicting the biologic augments and synthetic components that will be needed at the time of surgery. The rim of the acetabulum is intact and will support a hemispherical component. Conversion to arthroplasty should not be performed if arthrodesis is more than 15 years old.
The acetabular component has eroded superiorly and shifted to a vertical position. Results at a mean follow-up of 8.
Revision surgery with femoral head and polyethylene exchange and retroacetabular bone grafting. Inherent stability is not achievable with a trial implant. Migration is usually superolaterally because there is some if wall still left intact. Intraoperative decisions are based on findings when trial components are used; however, intraoperative findings can often be predicted by the preoperative AP radiograph of the pelvis when this classification system is used.
Immediate post-operative radiograph is shown in Figure A. A to year follow-up. Pelvic discontinuity occurs when the superior and inferior aspects of the hemipelvis are separated by a fracture through both columns.
The rim is intact and the columns are fully supportive of a hemispherical component. Ultrasound provides little information about bone loss but can be of use when a pseudo-tumour is suspected. Type IIIA defects demonstrate incomplete destruction of the teardrop medial wall of the teardrop present and it is completely obliterated in type IIIB defects. J Bone Joint Surg Am.
In our experience pre-operative angiography is only indicated in rare cases of catastrophic bone loss where an intra-pelvic approach will be required for retrieval of components.
Type IV pelvic discontinuity. Patients often present to a different institution or practice from where they had their index surgery. Porous-ingrowth revision acetabular implants secured with peripheral screws: Revision using an ilioischial reconstruction ring acetabular component and structural corticocancellous graft.
The incidence of THA revision has increased classifkcation during the last decade and is projected to nearly double by [ 89 ]. Cemented cup With good results reported for uncemented acetabular revision, cemented acetabular revision has become less favoured over the last two decades, particularly in the USA 37 In Raut et al 38 published disappointing results with cemented acetabular revision at a mean follow-up of 5.
Classifications In Brief: Paprosky Classification of Acetabular Bone Loss
A comparison of the reliability and validity of bone stock loss classification systems used for revision hip surgery. In Paprosky type 3 defects, major acetabular bone loss has occurred. Superior and lateral migration indicates greater involvement of the posterior column. J Bone Joint Surg Br vol. Three weeks later he dislocates the hip arising from the toilet seat.
Acetabular revision with use of a bilobed cementless component and morselized allograft. Obliteration of the canal due to trauma, fixation devices, or bony hypertrophy.
Wheeless’ Textbook of Orthopaedics
Cementless acetabular fixation at fifteen years. Interobserver agreement was moderate in both classification systems. Four criteria are used to assess the preoperative radiograph: Bone scan, gallium scan, and hip aspiration in the diagnosis of infected total hip arthroplasty.
Each has its own advantages and disadvantages. This article has been clasdification by other articles in PMC. Paprosky’s classification 7 is based on assessing the remaining host bone available to provide support for the acetabular component Table I and Figure 2. Despite its limitations, the Paprosky classification has many advantages including its defecrs familiarity, simplicity of use, the availability of routine perioperative radiographs, and reasonable reliability and validity.
The authors did comment, however, that similar results were published at the time for uncemented revisions.