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Grading acetabular defects: the need for a universal and valid system
Norman A Johanson1, Kim R Driftmier, Douglas L Cerynik
1Department of Orthopaedic Surgery, Hahnemann University Hospital, Philadelphia, Pennsylvania 19102, USA.
Abstract:
Preoperative classification of acetabular bone loss in revision total hip arthroplasty has been problematic. An evidence-based approach involves having a validated and widely accepted system of classification. A prerequisite would be a system that describes each defect in terms that are mutually exclusive, hierarchical, surgically relevant, and corresponding to experienced clinicians' preoperative estimates of surgical complexity. Of the 6 systems reviewed, only 1 demonstrated the reliability and validity required for a standardized grading system. Although high-grade defects were seen in only 17% of the 1094 hips, the failure rate associated with them was 30%. A larger population of high grade defects is necessary to determine which treatment alternatives are successful.
