Acetabular bone defects: classification and diagnosis

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Failure of the acetabular component of a total hip arthroplasty (THA) is frequently associated with bone loss as a result of loosening and osteolysis; it is likely that bone defects will be extended during implant removal. The amount and location of acetabular bone loss greatly influence the degree of technical difficulty of revision THA (rTHA) [1]. An accurate preoperative assessment of the bone defect is therefore extremely important for surgical planning and successful outcomes, with the ultimate goal to conserve bone stock and reconstruct bone defects to ensure the longevity of the revision. In the first part of this series of articles, Thomas Kostakos from the Henry Dunant Medical Center, Athens, Hellenic Republic (Greece), will explain the importance of acetabular bone loss estimation along with the existing classification systems and the methods employed for a diagnosis.

Several classification systems have been published: the American Academy of Orthopaedic Surgeons (AAOS) [2], Paprosky [1], Gustilo [3], Engh [4], Gross [5], Saleh [6], and Parry [7] systems. The AAOS and Paprosky systems have been most widely used in the orthopedic community; these two systems are explained in the following sections.

Thomas Kostakos

Henry Dunant Medical Center, Athens, Greece

AAOS classification

The AAOS classification (Table 1) divides acetabular deficiencies into two basic categories: segmental and cavitary defects [2]. The cavitary defects represent a loss in volume of the acetabular bone without compromising the acetabular rim, while segmental defects involve the complete loss of acetabular bony structural support for the prosthesis [2].

The AAOS classification is widely used. Despite that, it does not address the magnitude of the defects, nor does it shed light on the specific management options of the defects [8–10]. In addition, this classification system was deemed to have low to moderate reliability and its validity has not been well established [9, 11].

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  • AAOS classification
  • Paprosky Classification
  • Preoperative assessments
  • Radiologial evaluation for bone quality information
  • Hierarchical approach to preoperative imaging
  • Current classification limitations
  • When to engage CT
  • Magnetic resonance imaging
  • Conclusion

Part 2 | Managing bone defects using large acetabular cups and highly porous augments

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Part 3 | Management strategies for pelvic discontinuity

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AO Recon resources

Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):

Theofilos Karachalios

University General Hospital of Larissa at the University of Thessaly, Larissa, Greece

Thomas Kostakos

Henry Dunant Medical Center, Athens, Greece

George A Macheras

Henry Dunant Medical Center, Athens, Greece

The authors thank Maio Chen, medical writer at AO Innovation Translation Center, Switzerland, for contributing to the writing and editing of the articles.

References

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  2. D'Antonio JA, Capello WN, Borden LS, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989 Jun(243):126–137.
  3. Gustilo RB, Pasternak HS. Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening. Clin Orthop Relat Res. 1988 Oct(235):111–119.
  4. Engh CA GA. Cementless revision of failed total hip replacement: an update. Instr Course Lect. 1991;40:189–197.
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