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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Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft. J Am Acad Orthop Surg. Loss of bone of the supporting shell of femur. The authors did comment, however, that similar results were published at the time for uncemented revisions. CT is classification increasingly in preoperative planning; however, we are unaware of a classification system that incorporates this modality.

Classifications In Brief: Paprosky Classification of Acetabular Bone Loss

Loss of endosteal bone with intact cortical shell. The acetabular component has eroded superiorly and shifted to a vertical position. Early results of acetabular reconstruction using tantalum in cases of severe bone loss look promising Tantalum augments shaped as part of a hemisphere are available in various diameters and heights. A central segmental defect involves loss of the medial wall of the acetabulum.

He is unable to ambulate in the office.

J Arthroplasty ; 3: ESR is 12 normal Review Topic. Biomaterials 30 Additionally, it is worth remembering that the English-language literature on reliability and validity for the Paprosky system, while reasonably large for evaluations of a classification scheme, is still based on the findings of only 18 orthopaedists and hips [ 141219 ]. Only localized bone lysis is noted. Clinical and functional outcomes of the saddle prosthesis.


For the younger patient as much bone as possible is preserved or restored and an optimal hip centre is aimed for. Orthop Clin North Am ; A current radiograph is shown in Figure B.

Interobserver reliability was poor for both. Modern implants may provide better outcomes in the future. This article has been cited by other articles in PMC. In another study, Gozzard et al. Type 2A defects are oval enlargements of the acetabulum caused by superior bone lysis; however, the superior rim of the acetabulum is intact Fig. Book for revision if patient medically fit. Component migration is usually superomedially. If still asymptomatic and no progression of X-ray changes then repeat AP pelvis and lateral view of hip at 12 months.

The incidence of THA revision has increased substantially during the last decade and is projected to nearly double by [ 89 ].

Classifications In Brief: Paprosky Classification of Acetabular Bone Loss

cladsification The technique described by Schreurs et aP9 involved morcellising cancellous bone with a rongeur to chips 0. The implant has been refined from a mono-block design to the modular mark II saddle prosthesis with a conventional femoral stem and an additional artic-ulation.

There aas moderate, but not complete, destruction of the teardrop, and moderate lysis of the ischium. This can be a subtle superior displacement of the hip centre when a large hemispherical cup is used for spherical remodelling type IIIA or a significant displacement in cases of oblong remodelling type II B or large superior segmental defects type IIB Figure 6.

Author information Article notes Copyright and License information Disclaimer. Johnson et aP compared 6 classifications and found that the Saleh classification most reliably describes ‘the baseline characteristics that are most important to the surgeon for the purpose of planning a revision procedure and appropriately following the results.


Acetabular Reconstruction: Classification of Bone Defects and Treatment Options

The peripheral defects in types I and II are further divided by anatomic position: There have been fewer studies on the degree to which the classification actually reflects surgical findings validity. The left hip demonstrates placement of the acetabular component with a high hip center.

The supporting structures, including the acetabular walls and columns, are all intact and with no hip center component migration. Even with meticulous pre-operative planning, the final assessment of severity and location of bone loss is often made intra-operatively and reconstruction performed accordingly.

Superior migration of the hip center represents bone loss in the acetabular dome involving the anterior and posterior columns.

The need for a universal and valid system. The majority of these cases can be managed with an uncemented hemispherical cup. A lateral radiograph of the hip is usually performed to assess the femur and femoral component.

Subtle changes on a single radiograph can be difficult to interpret and bone loss is usually underestimated. This is a very promising modality that is less time-consuming and potentially more accurate than other nuclear studies 27, White cell scans and infected joint replacements.

In a separate study evaluating the AAOS and Paprosky systems, Campbell examined interobserver and intraobserver reliability for 33 hips needing revision hip classificagion.

A radiograph is shown in Figure A.