[Revision total hip arthroplasty: analysis of the predictive value of a radiographic classification system for assessment of bone stock loss].
OBJECTIVE
The aim of this study was to evaluate the predictive value of a radiographic classification system concerning implant and bone graft in revision total hip arthroplasty. This classification is used to assess bone stock loss prior to surgery, thus hypothetically enabling an adequate choice of the implant and bone graft required.


METHODS
33 consecutive patients with the diagnosis of aseptic failure of total hip arthroplasty were included in the study. The investigation was performed using the classification system according to Saleh et al. The predictive value was analyzed by comparing the radiographically based recommendation concerning implant and bone graft and the intraoperative procedure according to a blinded observer technique. The Spearman coefficient of correlation (r (s)) was used to establish levels of agreement among multiple ordinal variables.


RESULTS
Analysis of correlation between preoperative radiological estimations and intraoperative conclusions concerning implant and bone graft revealed coefficients of correlation (r (s)) of 0.53 (p < 0.01) for the acetabular and of 0.63 (p < 0.01) for the femoral classification.


CONCLUSIONS
Our results indicate that the Saleh classification does not provide sufficient information for preoperative assessment of the revision implant and bone graft required concerning the acetabular side, whereas planning of the operative procedure regarding the femoral implant seems to be possible. These ambivalent findings should be taken into account prior to revision total hip arthroplasty.
Käfer
W
W
Orthopädische Klinik mit Querschnittgelähmtenzentrum, Universität Ulm. wolframkaefer@hotmail.com
Kinkel
S
S
Puhl
W
W
Kessler
S
S
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001851:Bone Diseases, Metabolic / Q000145:classification* / Q000000981:diagnostic imaging* / Q000601:surgery; D016025:Bone Transplantation; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D010347:Patient Care Planning / Q000145:classification / Q000592:standards; D011183:Postoperative Complications / Q000145:classification* / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D015203:Reproducibility of Results; D013223:Statistics as Topic