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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 authors identify specific deficiencies that provide challenges at revision surgery without suggesting reconstruction options. Another concern with the technique is reported high failure rates in high-grade and uncontained deficiencies. Scher et al 25 do not aceatbular the routine use of In scanning to determine the presence of infection in the loose or painful total joint arthroplasty. Acetabular bone loss in revision total hip arthroplasty: Paprosky Classification The Paprosky classification system is based on the severity of bone loss and on the ability to obtain cementless fixation for a given bone loss pattern.

Definitive augments are attached to bone with screws. Most reported series were performed for classificattion of septic cases.

Figure Algorithmic approach to acetabular reconstruction. This is a very promising modality that is less time-consuming and potentially more accurate than other nuclear studies 27, Superior migration of the hip center represents bone loss in the acetabular dome involving the anterior and posterior columns.

With good results reported for uncemented acetabular revision, cemented acetabular revision has become less favoured over the last two decades, particularly defecta the USA 37 In Raut et al 38 published disappointing results with cemented acetabular revision at a mean follow-up of 5.

Restoring the optimal position of the acetabulum is important for providing the highest likelihood of hip stability. Some old techniques have stood the test of time and should not be forgotten. This should be pursued while minimising morbidity and cost.


Classifications In Brief: Paprosky Classification of Acetabular Bone Loss

L6 – years in practice. Core Tested Community All. Complications and functional evaluation of 17 saddle prostheses for resection of periacetabular tumors. Support Center Support Center. Type 3B defects Fig. Subsidence of the stem after impaction bone grafting for revision hip replacement using irradiated bone.

Salvage total hip reconstruction in patients with major acetabular bone deficiency using structural femoral head allografts. It is not without limitations and generally underestimates osteolysis Case Presentations with Questions and AnswersModerator: If a hemispherical cup is used for larger segmental defects or where remodelling of the acetabulum has occurred, it usually results in a change in the centre of rotation. However, revision hip arthroplasty usually is not indicated unless a specific problem is identified that can be surgically corrected.

Clinical notes or correspondence with the index surgeon must be obtained if possible, along with details of the implants used.

Open in a separate window. Excellent bony in-growth has been shown with porous metal tantalum. Superior and lateral migration indicates greater involvement of the posterior column.

Wheeless’ Textbook of Orthopaedics

Sporer 30 recommends angiography or vascular consultation in all cases where the acetabular component has migrated medially to the ilio-ischial line.

Revision to a cementless femoral component with diaphyseal press-fit fixation of the stem. It has been shown however to remain positive for up to 2 years following THA in asymptomatic patients and is of questionable value during this period. The remaining acetabular rim will not provide adequate initial component stability to achieve reliable biological fixation; therefore the trial implant lacks full intrinsic stability.

The predictive value claswification indium leukocyte scans in the diagnosis of infected total hip,knee, or resection arthroplasties. Screws or spikes may be required for initial stability. The trial component has full inherent stability; however, the hip center may be elevated as much as 1. A comparison of the validity and reliability of qcetabular bone stock loss classification systems and the proposal of a novel classification system.


Johnson et aP compared 6 classifications and found that the Saleh classification most reliably describes ‘the baseline characteristics that are most important to the surgeon for the purpose of planning a revision procedure and appropriately following the results. Management of acetabular bone loss in revision total hip arthroplasty. Segmental medial wall defects are closed off with slices of cortico-cancellous bone. The position of the implant relative to the ilio-ischial line Kohler’s line on the AP radiograph is preferred by some as a measure of medial migration because the teardrop may ddefects absent if anatomy was distorted by the original pathology.

Angiography or CT defefts to identify the major pelvic arteries may be indicated in certain cases. Please login to add comment. Like the Paprosky classification, the Saleh classification 9 aims to estimate the remaining supportive host bone stock following removal of the implant Table III.

THA Revision

Published online Aug Expert Opin Biol Ther. The rim of the acetabulum is intact and will support a hemispherical component.

Complete obliteration of the medial teardrop and severe lysis. The Saleh classification has been shown to have higher inter-observer reliability than other acetabular bone loss classifications. Salvage options The saddle prosthesis is designed to be used in cases of total acetabular bone loss. How would you treat this injury? Furthermore, given the Paprosky classification can be used to predict implant needs, this system is being used in an increasing number of studies to report midterm and long-term outcomes for revision THA with acetabular bone loss acetabulaar 151618 ].

The ilio-ischial line represents the posterior column and is usually disrupted in cases of pelvic discontinuity.