Reliability analysis of the ischial-gluteal pillar-based acetabular bone defect classification in hip revision surgery
10.3760/cma.j.cn121113-20250323-00284
- VernacularTitle:基于坐骨-臀肌柱的髋臼骨缺损分型在髋关节翻修术中的准确性分析
- Author:
Jingwei ZHANG
1
;
Zanjing ZHAI
1
;
Hua QIAO
1
;
Wenxuan FAN
1
;
Yuanqing MAO
1
;
Mengning YAN
1
;
Zhenan ZHU
1
;
Huiwu LI
1
Author Information
1. 上海交通大学医学院附属第九人民医院骨科，上海 200011
- Publication Type:Journal Article
- Keywords:
Reoperation;
Hip joint;
Acetabular bone defect;
Ischial-gluteal pillar;
Classification
- From:
Chinese Journal of Orthopaedics
2025;45(10):640-646
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the accuracy and clinical utility of a newly designed acetabular bone defect classification system based on the ischial-gluteal pillar in assessing the severity of acetabular bone defects and guiding hip revision surgery.Methods:A retrospective analysis was conducted on 474 patients who underwent hip revision surgery for prosthetic loosening after total hip arthroplasty at our institution from January 2010 to December 2020, including 296 males and 178 females with a mean age of 70.4±8.9 years (range: 52-86 years). The accuracy of our classification system in guiding surgical procedures was evaluated by comparing preoperative defect classifications with intraoperative findings. Clinical outcomes were evaluated using preoperative and final follow-up Harris hip scores (HHS) and Oxford hip scores (OHS), as well as the incidence of complications.Results:Preoperative classifications included 143 Type I, 192 Type II (Type IIa: 86 cases, Type IIb: 59 cases, Type IIc: 47 cases), 93 Type III (Type IIIa: 54 cases, Type IIIb: 27 cases, Type IIIc: 12 cases), and 46 Type IV cases (Type IVa: 32 cases, Type IVb: 9 cases, Type IVc: 5 cases). Compared with intraoperative findings, classification accuracy was 99.3% for Type I (1 errors), 98.4% for Type II (3 errors), 97.8% for Type III (2 errors), and 97.8% for Type IV (1 misclassified as Type III). The mean follow-up was 5.8±4.4 years (range: 2-12 years). At final follow-up, mean HHS improved from 36.65±10.27 to 91.36±7.53, and mean OHS increased from 11.35±4.36 to 44.6±5.27 with significant difference ( P<0.001). Complications included one Type IV periprosthetic infection, one Type II hip dislocation, one Type I and two Type IV re-revisions (due to femoral loosening or graft resorption), one Type II and one Type III death unrelated to surgery, and one Type I postoperative thigh hematoma. No neurovascular injuries occurred. Conclusions:This novel 3D acetabular bone defect classification system, based on ischial-gluteal pillar integrity, provides accurate preoperative assessment and effectively guides surgical planning. Its application demonstrates favorable mid-term outcomes in hip revision surgery.
