title: The inter-observer and intra-observer reliability of the Paprosky femoral bone loss classification system.
abstract: The Paprosky classification provides a straightforward algorithm for defining bone loss and directing treatment for femoral revision. The purpose of this study was to test the inter-observer and intra-observer reliability of this system. Four arthroplasty surgeons reviewed radiographs of 205 consecutive femoral revisions. For each radiograph, the pattern of femoral bone loss was classified by Paprosky type on two separate occasions. A kappa value was used to calculate the reliability, which demonstrated an inter-observer reliability of 0.61, indicating substantial agreement between surgeons. The intra-observer reliability for each of the 4 participating surgeons was 0.81, 0.78, 0.76, and 0.75, indicating substantial to almost perfect agreement. There is substantial agreement among experienced arthroplasty surgeons when using the Paprosky Classification to characterize femoral bone loss.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Brown
authors.affiliation: Panorama Orthopedics and Spine Center Golden, Colorado.
authors.forename: Jared R H
authors.initials: JR
authors.lastname: Foran
authors.affiliation: Adult Reconstructive Fellowship, Rush University Medical Center, Chicago, Illinois.
authors.forename: Craig J Della
authors.initials: CJ
authors.lastname: Valle
authors.affiliation: Department of Anesthesia, Rush University Medical Center, Chicago, Illinois.
authors.forename: Mario
authors.initials: M
authors.lastname: Moric
authors.affiliation: Rush University Medical Center, Chicago, Illinois.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sporer
authors.affiliation: Rush University Medical Center, Chicago, Illinois.
authors.forename: Brett R
authors.initials: BR
authors.lastname: Levine
authors.affiliation: Rush University Medical Center, Chicago, Illinois.
authors.forename: Wayne G
authors.initials: WG
authors.lastname: Paprosky
mesh_terms: D000465:Algorithms; D001178:Arthroplasty / Q000379:methods*; D001862:Bone Resorption / Q000175:diagnosis* / Q000503:physiopathology; D005269:Femur / Q000503:physiopathology*; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: Paprosky femoral classification system; femoral bone loss; interobserver variation; intraobserver variation; revision hip arthroplasty; total hip arthroplasty