title: Validity and reliability of the Paprosky acetabular defect classification.
abstract: BACKGROUND
  The Paprosky acetabular defect classification is widely used but has not been appropriately validated. Reliability of the Paprosky system has not been evaluated in combination with standardized techniques of measurement and scoring.
  
  
  OBJECTIVE
  This study evaluated the reliability, teachability, and validity of the Paprosky acetabular defect classification.
  
  
  METHODS
  Preoperative radiographs from a random sample of 83 patients undergoing 85 acetabular revisions were classified by four observers, and their classifications were compared with quantitative intraoperative measurements. Teachability of the classification scheme was tested by dividing the four observers into two groups. The observers in Group 1 underwent three teaching sessions; those in Group 2 underwent one session and the influence of teaching on the accuracy of their classifications was ascertained.
  
  
  RESULTS
  Radiographic evaluation showed statistically significant relationships with intraoperative measurements of anterior, medial, and superior acetabular defect sizes. Interobserver reliability improved substantially after teaching and did not improve without it. The weighted kappa coefficient went from 0.56 at Occasion 1 to 0.79 after three teaching sessions in Group 1 observers, and from 0.49 to 0.65 after one teaching session in Group 2 observers.
  
  
  CONCLUSIONS
  The Paprosky system is valid and shows good reliability when combined with standardized definitions of radiographic landmarks and a structured analysis.
  
  
  METHODS
  Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors: Orthopaedic & Trauma Service, Department of Orthopaedic & Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors: Raymond
authors: R
authors: Yu
authors: Jochen G
authors: JG
authors: Hofstaetter
authors: Thomas
authors: T
authors: Sullivan
authors: Kerry
authors: K
authors: Costi
authors: Donald W
authors: DW
authors: Howie
authors: Lucian B
authors: LB
authors: Solomon
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D059925:Anatomic Landmarks; D019644:Arthroplasty, Replacement, Hip; D006801:Humans; D015588:Observer Variation; D011237:Predictive Value of Tests; D011859:Radiography; D012086:Reoperation; D015203:Reproducibility of Results