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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The remaining anterior and posterior rims and columns are supportive of an implant.

THA Revision – Recon – Orthobullets

Bone grafts in hip replacement surgery. Function after removal of a septic total hip prosthesis. Results at a mean follow-up of 8. Over the past decade, improvements in technology and surgical technique have made acetabular revision more successful and straightforward.

Classifications In Brief: Paprosky Classification of Acetabular Bone Loss

Persistent pain from the time of surgery suggests infection, fracture, impingement or failure of initial stability of uncemented prostheses.

Reconstruction of these defects is similar to the treatment of protrusio acetabuli in the setting of a primary arthroplasty. In an attempt to better define these defects, classification systems are used. Judet oblique pelvic views can be helpful if pelvic discontinuity is suspected. Several authors have classified acetabular bone loss.

Migration of the component occurs superior and lateral because the acetabular rim is deficient. Purpose Given the complexity of revision THA, the Paprosky system identifies which acetabular supporting structures are deficient for the purposes of predicting the biologic augments and synthetic components that will be needed at the time of surgery.

A og radiograph of the pelvis is shown in Figure A. The priorities when planning the reconstruction are to provide a stable implant, to restore bone stock and to optimise the biomechanics of the hip.

Finally, femoral bone stock also must be considered because a successful outcome depends on appropriate management of both sides of the hip. Good outcome in 43 patients followed for a mean of 2 years. To this end, Della Valle and Paprosky proposed a classification system for femoral bone loss [ 17 ], which was intended to be used in conjunction with the acetabular classification.


The treatment of pelvic discontinuity during acetabular revision. Migration of the component into a cavitary defect is evident medial to a thinned superior rim and is directed superior or superior medial. Intraoperative decisions are based on findings when trial components are used; however, intraoperative findings can often be predicted by the preoperative AP radiograph of the pelvis when this classification system is used.

Managing deficient acetabular bone in primary and revision total hip arthroplasty requires thought and planning. CT scan provides more information about bone quantity and quality than plain X-ray. Definitive augments are attached to bone with screws. Type 2B defects are characterized by a deficient superior dome, allowing for superior and lateral component migration owing to the lack of a lateral stabilizing buttress, normally provided by the lateral margin of the superior dome.

If still asymptomatic and no progression of X-ray changes then repeat AP pelvis and lateral view of hip at 12 months.

Although agreement is limited, the Paprosky classification performs as well as or better than other acetabular classification schemes. J Bone Joint Surg [Br] ; In these cases a stable pseudoarthrosis develops and reasonable outcomes have been reported 68,69 Limb shortening and instability are the concerns if a Girdlestone procedure is performed in cases of severe bone loss.

Classifications In Brief: Paprosky Classification of Acetabular Bone Loss

The complexity of the problem of od bone loss in revision surgery and the limitations of radiographic assessment make it impossible to devise a perfect classification system that is simple, reproducible, suggests management options and predicts outcome.

A conventional extensile approach will suffice in these cases and angiography is not required.

Paprosky developed the classification evaluating patients. The rim is enlarged and the medial wall is destroyed. Cancellous screw or reconstruction plate outside acetabulum. Type 2 defects have moderate bone loss, deficient walls but intact acetabular columns, and less then 2 cm of hip center migration.


Case Presentations with Questions and AnswersModerator: Revision arthroplasty with a fully coated cementless stem, cable wiring, and bone graft. Positron emission tomography PET with fluorodeoxyglucose FDG measures biological activity of particularly macrophages and neutrophils, with an increased glucose uptake in areas of infection.

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.

The Paprosky classification system was designed to provide guidance on when cementless components are appropriate and when other techniques should be used. The classification does not clearly define moderate or severe osteolysis. Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft.

How important is this topic for board examinations? Sequentially larger reamers are used until the acetabular rim is engaged. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty.

Acetabular revision using an anti-protrusion ilio-ischial cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. Preoperative planning is a critical aspect of any reconstructive hip surgery but is particularly important in revision surgery. Templating is an important step in pre-operative planning of revision surgery.

In these patients, nonsurgical treatment such as activity modification, ambulatory aids, and oral analgesics may be appropriate. A radiograph is shown in Figure C. Intraobserver reliability of the originators was moderate for both, with the Paprosky classification being slightly more reliable. This chapter will discuss the two most popular classification systems used to describe acetabular bone defects.