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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Wheeless’ Textbook of Orthopaedics
Although this classification does define acetabular defects, its major flaw as a classification system is that it does not address the management of these defects. A central segmental defect involves loss of the medial wall of the acetabulum.
Four criteria are used to assess the preoperative radiograph: Five years after the original study, Campbell et al. Superior and lateral migration indicates greater involvement of the posterior column.
Revision total hip arthroplasty: addressing acetabular bone loss
The aims of acetabular revision are to provide a functional, pain-free hip. A comparison of the reliability and validity of bone stock loss classification systems used for revision hip surgery.
Management of periacetabular bone loss in revision hip arthroplasty. ESR is 12 normal Review Topic. A 6-year follow-up evaluation.
This should be pursued while minimising morbidity and cost. Instr Course Lect ; This defect is classified as a type IIC. 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. Type 3A defects have moderate-to-severe destruction of the acetabular walls and posterior column, rendering these structures nonsupportive.
Although these studies show that neither of these classification systems is perfect, both agree that some form of classification should be used to facilitate communicate between surgeons and to compare outcomes. Contained defects with an intact rim are not usually problematic. A comparison with the same surgeon’s results following acetabular fixation with cement.
The patient undergoes a closed reduction and is placed in a hip abduction brace. Would you rule out infection in this case and how? Smaller areas of lysis may not be seen well on radiographs alone and certain structures such as the ischium may be obscured by the radiopaque cup making accurate determinations of defect size difficult.
All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Acetabular bone loss, acetabular deficiency, revision hip arthroplasty, acetabular management.
In addition to prosthesis related outcomes, studies should explore the patient experience of revision hip replacement incorporating bone graft substitute material. In patients with metal-on-metal MoM bearing THA, MRI may be a useful pre-operative investigation for suspected adverse reactions to metal debris including pseudo-tumours and metallosis.
Revision arthroplasty using an antiprotrusio cage for massive acetabular bone deficiency.
Acetabular component failure was a more common reason for revision than deep infection. Intraobserver and interobserver reliabilities have been shown to be highly variable, but generally achieve only fair to moderate agreement [ 141219 ]. This gives the surgeon the opportunity to pre-operatively match different cups or augments to available bone and to work out angles for screw fixation. Investigations Before formulating a management plan for the THA patient with bone loss, special investigations are aimed at: Bone graft substitutes can be used in isolation or in combination with auto- or clwssification.
Validity and reliability of the Paprosky acetabular defect classification.
How would you treat this injury? These factors must be addressed in the xcetabular process of the reconstruction and can be completed in such a way that the likelihood of success is optimized. Figure Type 2B acetabular defect. Glithero et al 26 report false negatives poor sensitivity in chronic peri-prosthetic infection.
Only localized bone clssification is noted. Acetabular defects were graded pre-operatively on a plain AP radiographs. When the medial wall is absent, the teardrop is obliterated and there is medial migration of the component.
Partial destruction of the teardrop is seen, but the medial limb usually is still present. The intra- and inter-observer reliability of the Paprosky classification of plain radiographs have been found to be moderate to poor by other authors.
What is the most likely cause of the patient’s current hip pain symptoms? Please login to add comment. Type 2 defects are further subdivided into A, B, and C based on defect location and resultant direction of component migration.
Acetabular defect classification and surgical reconstruction in revision arthroplasty: Acetabular bone loss in revision total hip arthroplasty: