Decision/therapeutic algorithm for acetabular revisions

Main Article Content

Alessandro Aprato
Matteo Olivero
Paolo Di Benedetto
Alessandro Massè


acetabular revision; bone loss; revision indications; CT-based algorithm.


Background and aim: Paprosky’s classification is currently the most used classification for periacetabular bone defects but its validity and reliability are widely discussed in literature. Aim of this study was to introduce a new CT-based Acetabular Revision Algorithm (CT-ARA) and to evaluate its validity. The CT-ARA is based on the integrity of five anatomical structures that support the acetabulum. Classification’s groups are defined by the deficiency of one or more of these structures, treatment is based on those groups.

Methods: In 105 patients the validity of the CT-ARA was retrospectively evaluated using preoperative X-rays, CT-scan and surgery reports. The surgical indications suggested by Paprosky’s algorithm and by CT-ARA were compared with the final surgical technique. Patients were divided into two groups according to time of surgery.

Results: We reported concordance of indications in 56,2% of cases with the Paprosky’s algorithm and in 63,8% of cases with the CT-ARA. Analysing only the most recent surgeries (group 2), we reported even higher difference of concordance (67,3% Paprosky’s algorithm and 83,7% CT-ARA). The concordance of the CT-ARA among Group 1 and Group 2 resulted significantly different.

Conclusions: the CT-ARA may be a useful tool for the preoperative decision-making process and showed more correlation with performed surgery compared to the Paprosky’s algorithm.


Download data is not yet available.
Abstract 251 | PDF Downloads 61


1. Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the u.s., 2014 to 2030. J Bone Jt Surg - Am Vol. 2018;100(17):1455–60.
2. Fehring KA, Howe BM, Martin JR, Taunton MJ, Berry DJ. Preoperative Evaluation for Pelvic Discontinuity Using a New Reformatted Computed Tomography Scan Protocol. J Arthroplasty [Internet]. 2016;31(10):2247–51.
3. Aprato A, Olivero M, Iannizzi G, Bistolfi A, Sabatini L, Masse A. Pelvic discontinuity in acetabular revisions: does CT scan overestimate it? A comparative study of diagnostic accuracy of 3D-modeling and traditional 3D CT scan. Musculoskelet Surg [Internet]. 2020;104(2):171–7.
4. Telleria JJM, Gee AO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res. 2013;471(11):3725–30.
5. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994;9(1):33–44.
6. Wirtz DC, Jaenisch M, Osterhaus TA, et al. Acetabular defects in revision hip arthroplasty: a therapy-oriented classification. Arch Orthop Trauma Surg [Internet]. 2020;140(6):815–25.
7. Paprosky WG, O’Rourke M, Sporer SM. The treatment of acetabular bone defects with an associated pelvic discontinuity. Clin Orthop Relat Res. 2005;(441):216–20.
8. Gozzard C, Blom A, Taylor A, Smith E, Learmonth I. A comparison of the reliability and validity of bone stock loss classification systems used for revision hip surgery. J Arthroplasty. 2003;18(5):638–42.
9. Horas K, Arnholdt J, Steinert AF, Hoberg M, Rudert M, Holzapfel BM. Acetabular defect classification in times of 3D imaging and patient-specific treatment protocols. Orthopade. 2017;46(2):168–78.
10. Paprosky WG, Cross MB. CORR insights ® : Validity and reliability of the Paprosky acetabular defect classification. Clin Orthop Relat Res. 2013;471(7):2266.
11. Garcia-Cimbrelo E, Tapia M, Martin-Hervas C. Multislice computed tomography for evaluating acetabular defects in revision THA. Clin Orthop Relat Res. 2007;(463):138–43.
12. Leung S, Naudie D, Kitamura N, Walde T, Engh CA. Computed Tomography in the Assessment of Periacetabular Osteolysis. J bone Jt Surg. 2005;87-A(3):592–7.
13. Judet R, Judet J, Letournel E. Fractures of the acetabulum. Classification and surgical approaches for open reduction. Preliminary report. J Bone Jt Surg. 1964;(46):1615–36.
14. Aprato A, Olivero M, Vergano LB, Massè A. Outcome of cages in revision arthroplasty of the acetabulum: A systematic review. Acta Biomed. 2019;90:24–31.
15. García-Cimbrelo E, García-Rey E. Bone defect determines acetabular revision surgery. HIP Int. 2014;24(2):S33–6.
16. Massè A, Aprato A, Turchetto L, et al. Reconstruction with rib graft for acetabular revision in pelvic discontinuity: An extreme solution? Tech Orthop. 2015;30(4):269–74.
17. Sporer SM. How to do a revision total hip arthroplasty: Revision of the acetabulum. J Bone Jt Surg - Ser A. 2011;93(14):1359–66.
18. Sporer SM, O’Rourke M, Paprosky WG. The treatment of pelvic discontinuity during acetabular revision. J Arthroplasty. 2005;20(SUPPL. 2):79–84.
19. Volpin A, Konan S, Biz C, Tansey RJ, Haddad FS. Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review. Musculoskelet Surg [Internet]. 2019;103(1).
20. Claus AM, Engh CAJ, Sychterz CJ, Xenos JS, Orishimo KF, Engh CAS. Radiographic definition of pelvic osteolysis following total hip arthroplasty. J Bone Joint Surg Am. 2003 Aug;85(8):1519–26.
21. Yu R, Hofstaetter JG, Sullivan T, Costi K, Howie DW, Solomon LB. Validity and reliability of the paprosky acetabular defect classification hip. Clin Orthop Relat Res. 2013;471(7):2259–65.

Most read articles by the same author(s)

1 2 3 4 > >>