• Dieter Christian Wirtz, Max Jaenisch, Thiemo Antonius Osterhaus, Martin Gathen, Matthias Wimmer, Thomas Martin Randau, Frank Alexander Schildberg, and Philip Peter Rössler.
• Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
• Arch Orthop Trauma Surg. 2020 Jun 1; 140 (6): 815-825.

IntroductionThe treatment of severe acetabular bone loss remains a difficult challenge. No classification system is available that combines intuitive use, structured design and offers a therapeutic recommendation according to the current literature and modern state of the art treatment options. The goal of this study is to introduce an intuitive, reproducible and reliable guideline for the evaluation and treatment of acetabular defects.MethodsThe proposed Acetabular Defect Classification (ADC) is based on the integrity of the acetabular rim and supporting structures. It consists of 4 main types of defects ascending in severity and subdivisions narrowing down-defect location. Type 1 presents an intact acetabular rim, type 2 includes a noncontained defect of the acetabular rim ≤ 10 mm, in type 3 the rim defect exceeds 10 mm and type 4 includes different kinds of pelvic discontinuity. A collective of 207 preoperative radiographs were graded according to ADC and correlated with intraoperative findings. Additionally, a randomized sample of 80 patients was graded according to ADC by 5 observers to account for inter- and intra-rater reliability.ResultsWe evaluated the agreement of preoperative, radiographic grading and intraoperative findings presenting with a k value of 0.74. Interobserver agreement presented with a k value of 0.62 and intraobserver at a k value of 0.78.ConclusionThe ADC offers an intuitive, reliable and reproducible classification system. It guides the surgeon pre- and intraoperatively through a complex field of practice.

28 keywords...

hide…