4. Paprosky classification of femoral bone deficiencies

#### 4.1. Introduction

This classification was described by Wayne Paprosky et al. from Illinois, USA. He emphasized that his classification will help the surgeon determine the most appropriate option for

Figure 3. Paprosky classification.

mostly the medial wall but the columns are intact, then this type of defect is considered type II

Type V Acetabular defect with uncontained loss of bone stock in association with pelvic

Gozzard et al. had observed an Inter-observer reliability testing revealed kappa values of 0.89 for the acetabulum. Average validation value was kappa = 0.86 for the acetabulum [2]. To put things into perspective: clinical epidemiologists consider correlation values of 0.6–0.8 to be

3. Hodgkinson classification of radiographic demarcation of the socket

This classification was proposed by Hodgkinson et al. from Wrightington, UK in 1988. He reviewed 200 patients undergoing revision arthroplasty and found out strong correlation between the extent of radiographic demarcation at bone-cement interface and intraoperative

This classification helps surgeon help decide between partial or complete revision preoperatively.

This classification was described by Wayne Paprosky et al. from Illinois, USA. He emphasized that his classification will help the surgeon determine the most appropriate option for

4. Paprosky classification of femoral bone deficiencies

because of the availability of the columns for reconstruction).

"substantial" and between 0.8 and 1.0 to be "perfect association".

following total hip arthroplasty

Type 1: Demarcation of outer one-third.

Type 3: Complete demarcation.

Type 4: Socket migration.

3.3. Clinical significance

4.1. Introduction

loosening of cemented acetabular components [4].

Type 2: Demarcation of outer and middle thirds.

discontinuity.

22 Total Hip Replacement - An Overview

2.3. Reliability

3.1. Introduction

3.2. Classification

Type 0: No demarcation.

reconstruction and thereby assists with ensuring that the appropriate implants and instruments are available at the time of surgery [5]. Gozzard et al. found moderate agreement between the preoperative and intraoperative validity; but the reliability of the classification was found to be fair (Figure 3).

#### 4.2. Classification

Type 1: Minimal metaphyseal and diaphyseal bone loss.

Type 2A: Absent calcar extend just below the inter-trochanteric region.

Type 2B: Anterolateral metaphyseal bone loss wit absent calcar.

Type 2C: Posteromedial metaphyseal bone loss.

Type 3A: 2A plus diaphyseal bone loss but at least 4 cm of diaphyseal support possible.

Type 3B: 2B plus diaphyseal bone loss with less than 4 cm of diaphyseal support available.

Type 3C: 2C plus complete diaphyseal bone loss.

#### 4.3. Clinical applications

Type 1: Cemented or proximally porous coated cementless implant can be used.

Type 2A, 2B, 2C: Extensively porous coated cementless stem is preferred. Cemented stem should be avoided because of loss of metaphyseal endosteal bone.

Type 3A: Extensively porous coated stems or modular distal fitting tapered stems can be used.

Type 3B: Modular tapered cementless stems are used if adequate bone stock.

Impaction bone grafting is also an option.

Type 4: Impaction bone grafting with tapered cemented stem if intact cortex. Composite prosthesis allograft if no proximal cortex. Long cemented stem is an option in elderly.

5.3. Clinical applications

5.4. Reliability

6.1. Introduction

6.2. Classification

in length

of bone stock.

6.3. Reliability

following implant removal [3].

guiding the surgeon determine the reconstructive option.

agreement (k value of 1.0) among the registrars.

6. Saleh classification of femoral bone deficiencies

Type Defect Treatment

III Non-circumferential loss of bone stock uncontained

IV Circumferential loss of bone stock more than 5 cm in

V Periprosthetic fracture with proximal circumferential loss

length (distal to lesser trochanter)

ble treatment options for each type.

Proximal circumferential loss of bone stock less than 5 cm

I No significant loss of bone stock. Conventional cemented

II Contained loss of bone stock, cortical sleeve intact Proximal fixation

This classification is very useful in describing the bone defect accurately but has less role in

Gozzard et al. in their study observed the inter observer agreement among consultants and registrars. They noted a fair agreement (k value of 0.28) among consultants and a poor

This system of classification was proposed by Saleh et al. in 1999. The study had included 21 expert arthroplasty surgeons and was proposed based on estimation of anticipated bone stock

In the study by Saleh et al., they noted an inter observer reliability of k value 0.88 and average validity, k value of 0.88; indicating perfect association. The classification also provides proba-

Uncemented components

Impaction grafting Porous coated implant Modular implant

Cortical strut allograft Calcar replacing prosthesis

Custom implant, proximal femoral allograft

Restoration of bone stock plus long stem femoral component custom implant proximal femoral allograft.

Classifications Used in Total Hip Arthroplasty http://dx.doi.org/10.5772/intechopen.77231 25
