11. Brooker's classification

#### 11.1. Introduction

This system was proposed by Brooker et al. from John Hopkins Hospital in 1973 on a series of 100 consecutive patients undergoing Total hip arthroplasty. Since then it has been in widespread use and has stood the test of time [12].

#### 11.2. Classification

10. Tsukayama classification of infected hip joint prosthesis

Tsukayama et al. proposed the classification based on the study of 97 patients with infected hip

Positive intraoperative cultures: Two out of five intraoperative specimens positive on culture in a patient undergoing revision hip arthroplasty with no clinical evidence of infection at the time

Early postoperative infection: Wound infection developed less than 1 month after the operation. Late chronic infection: Wound infection developed 1 month or more after the index operation

Acute hematogenous infection: Associated with a documented or suspected antecedent bacteremia and characterized by an acute onset of symptoms in the affected joint with the prosthesis.

Positive intraoperative cultures: Intravenous administration of antibiotics for 6 weeks without

Early postoperative infection: Debridement, replacement of the polyethylene inserts of the acetabular component, retention of the prosthesis, and intravenous administration of antibi-

Late chronic infection: Debridement; removal of all prosthetic components and bone cement; and placement of antibiotic beads. Intravenous antibiotics for 6 weeks. Revision arthroplasty

Acute hematogenous infection: Debridement, replacement of the polyethylene insert, retention of the prosthesis if it was not loose, and intravenous administration of antibiotics for 6 weeks [11].

This system was proposed by Brooker et al. from John Hopkins Hospital in 1973 on a series of 100 consecutive patients undergoing Total hip arthroplasty. Since then it has been in wide-

10.1. Introduction

30 Total Hip Replacement - An Overview

joint prosthesis [11].

10.2. Classification

and with insidious course.

operative intervention.

otics for 4 weeks.

11.1. Introduction

10.3. Clinical implication (treatment guidelines)

2 weeks after cessation of antibiotic therapy.

spread use and has stood the test of time [12].

11. Brooker's classification

of revision.

Class I: Isolated islands of bone.

Class II: Gap between bones at least 1 cm.

Class III: Gap between bones less than 1 cm.

Class IV: Apparent ankylosis.

#### 11.3. Clinical application

This classification is useful in the follow up of the high-risk patients and in patients with post HO resection.

#### 11.4. Reliability

Vasileiadis et al. from mayo clinic in their study noted a moderate to substantial agreement (k value 0.49–0.71) in the inter observer reliability. Grade IV had best inter observer reliability [13, 14] (Figure 8).

Figure 8. Brooker classification.
