title: Acetabular defect classification in times of 3D imaging and patient-specific treatment protocols.
abstract: Parallel to the rising number of revision hip procedures, an increasing number of complex periprosthetic osseous defects can be expected. Stable long-term fixation of the revision implant remains the ultimate goal of the surgical protocol. Within this context, an elaborate preoperative planning process including anticipation of the periacetabular defect form and size and analysis of the remaining supporting osseous elements are essential. However, detection and evaluation of periacetabular bone defects using an unsystematic analysis of plain anteroposterior radiographs of the pelvis is in many cases difficult. Therefore, periacetabular bone defect classification schemes such as the Paprosky system have been introduced that use standardized radiographic criteria to better anticipate the intraoperative reality. Recent studies were able to demonstrate that larger defects are often underestimated when using the Paprosky classification and that the intra- and interobserver reliability of the system is low. This makes it hard to compare results in terms of defects being studied. Novel software tools that are based on the analysis of CT data may provide an opportunity to overcome the limitations of native radiographic defect analysis. In the following article we discuss potential benefits of these novel instruments against the background of the obvious limitations of the currently used native radiographic defect analysis.
authors.affiliation: Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Horas
authors.affiliation: Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Arnholdt
authors.affiliation: Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany.
authors.forename: A F
authors.initials: AF
authors.lastname: Steinert
authors.affiliation: Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hoberg
authors.affiliation: Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Rudert
authors.affiliation: Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany. holzapfel@orthopaedic-oncology.net.|Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4049, Brisbane, QLD, Australia. holzapfel@orthopaedic-oncology.net.
authors.forename: B M
authors.initials: BM
authors.lastname: Holzapfel
mesh_terms: D065526:Acetabuloplasty / Q000379:methods*; D000465:Algorithms; D019317:Evidence-Based Medicine; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D010014:Osteolysis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: 3D analysis; Acetabular bone defects; Acetabular revision arthroplasty; Computed tomography; Paprosky classification