• Arch Orthop Trauma Surg · Jan 2023

    Review

    Bone defect classifications in revision total knee arthroplasty, their reliability and utility: a systematic review.

    • Yasim Khan, Sumit Arora, Abhishek Kashyap, Mohit Kumar Patralekh, and Lalit Maini.
    • Department of Orthopaedic Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, 110002, India. yashimnp@gmail.com.
    • Arch Orthop Trauma Surg. 2023 Jan 1; 143 (1): 453468453-468.

    BackgroundThere are various classification systems described in the literature for managing bone defects in revision knee arthroplasty (RTKA). We analysed the reliability and usefulness of these classification systems.Questions/Purposes(1) To review and critique the various classification systems proposed for bone loss in RTKA. (2) Among all the proposed classifications which one is the most commonly used by surgeons to report their results. (3) What is the reliability of various bone defect classification systems for RTKA. In this review, we have assessed the studies validating those classifications with a detailed description of the limitations and the proposed modifications.MethodsThis systematic review was conducted following PRISMA guidelines. Pubmed/Medline, CINAHL, EMBASE, Scopus, Cochrane databases and Web of Science databases were searched using multiple search terms and MeSH terms where possible. Studies meeting inclusion criteria were assessed for statistical parameters of reliability of a classification system.ResultsWe found 16 classification systems for bone defects in RTKA. Six studies were found evaluating a classification system with reporting their reliability parameters. Fifty-four studies were found which classified bone loss using AORI classification in their series. AORI classification is most commonly reported for classifying bone defects. Type T2B and F2B are the most common bone defects in RTKA. The average kappa value for AORI classification for femoral bone loss was 0.38 (0.27-0.50) and 0.76 (0.63-1) for tibial bone loss assessment.ConclusionNone of the available classification systems is reliably established in determining the bone loss and treatment plans in RTKA. Among all, AORI classification is the most widely used system in clinical practice. The reliability of AORI Classification is fair for femoral bone loss and substantial for tibial bone loss.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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