Development of the Revision Hip Complexity Classification using a modified Delphi technique

Area of Science:

• Orthopedic Surgery
• Surgical Complexity Classification
• Hip Revision Arthroplasty

Background:

• Complex hip revision cases require standardized assessment for effective multidisciplinary team (MDT) discussions.
• Existing classification systems may not fully capture the nuances of surgical complexity and patient comorbidities in hip revisions.

Purpose of the Study:

• To develop a structured Revision Hip Complexity Classification (RHCC) using a modified Delphi process.
• To create a tool to aid MDT discussions for complex hip revision cases within local or regional networks.

Main Methods:

• A modified Delphi process involving 35 experts from the British Hip Society.
• Three rounds of questionnaires and a virtual meeting were conducted to identify, weight, and group complexity factors.
• Incorporated existing classification systems (Paprosky, Unified Classification System, ASA) into the RHCC framework.

Main Results:

• Achieved strong consensus on 32 out of 36 identified factors.
• The RHCC demonstrated good intraobserver (Kappa 0.88-0.92) and interobserver (Kappa 0.77-0.85) reliability.
• Incorporated American Society of Anesthesiologists (ASA) grade III/IV patients with an asterisk qualifier.

Conclusions:

• The RHCC provides a comprehensive and reproducible framework for discussing complex hip revision cases.
• Adoption of the RHCC can improve the description of surgical complexity and influence patient management decisions.
• Facilitates standardized communication within hip revision multidisciplinary teams.