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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.

The Journal of Arthroplasty

|April 21, 2009

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Classifying acetabular bone loss in hip revision surgery is challenging. Only one of six reviewed systems proved reliable and valid for standardized grading, highlighting the need for better preoperative assessment tools.

Area of Science:

Orthopedic Surgery
Arthroplasty Research
Surgical Classification Systems

Background:

Preoperative classification of acetabular bone loss in revision total hip arthroplasty (THA) presents significant challenges.
A validated and widely accepted classification system is crucial for an evidence-based approach.
Existing systems often lack mutual exclusivity, hierarchy, surgical relevance, or correlation with perceived surgical complexity.

Purpose of the Study:

To evaluate the reliability and validity of existing classification systems for acetabular bone loss in revision THA.
To identify a standardized grading system suitable for preoperative assessment and surgical planning.

Main Methods:

A systematic review of six classification systems for acetabular bone loss in revision THA was conducted.

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Systems were assessed based on criteria including mutual exclusivity, hierarchy, surgical relevance, and correlation with preoperative complexity estimates.

Reliability and validity of the systems were evaluated.

Main Results:

Only one of the six reviewed classification systems demonstrated the necessary reliability and validity for standardization.
High-grade acetabular defects, present in 17% of 1094 hips, were associated with a substantial failure rate of 30%.
The study highlights a need for further investigation into treatment alternatives for high-grade defects.

Conclusions:

A significant gap exists in validated preoperative classification systems for acetabular bone loss in revision THA.
The identified reliable and valid system offers a standardized approach to defect description and complexity assessment.
Further research with larger cohorts of high-grade defects is required to establish successful treatment strategies.