• Mattia Loppini, Edoardo Guazzoni, Francesco Manlio Gambaro, Francesco La Camera, Emanuela Morenghi, and Guido Grappiolo.
• Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy. mattia.loppini@gmail.com.
• Arch Orthop Trauma Surg. 2024 Jul 1; 144 (7): 297529812975-2981.

BackgroundThe increasing amount of revision surgeries in total hip arthroplasty (THA) represents a burden for orthopedic surgeons given the complexity and unpredictability of this kind of surgery. The aim of the current study was to develop a new radiographic classification of acetabular bone defects stratify the severity of the lesion and to suggest the surgical strategy to address it.MethodsRadiographs of 151 consecutive patients who underwent acetabular revision surgery in our institution were collected to develop a new classification that groups the acetabular bone defects in three zones (A, B and C). The performance to predict treatment and inter- and intra-rater agreement were evaluated.ResultsThe ability of the newly proposed classification to predict treatment was 87.3% (k weighted: 0.65). The inter-rater reliability was 90.1% (k: 0.81), and the intra-rater reliability between the two sets of evaluations performed by the observer at 1-month distance was 97.5% (k: 0.94).ConclusionsThe newly proposed classification was able to characterize the extent of acetabular bone defects and predict pre-operatively the appropriate surgical treatment strategy in 87.3% of cases. It showed a strong agreement among raters and an almost perfect agreement among different measurements at 1 month distance. This new tool could be used in the preoperative assessment to drive the use of secondary level image examinations and the type of surgical management.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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