The Influence of Computed Tomography on the Preoperative Planning of Revision Hip Arthroplasty – Femoral Component

Objective: The present study aimed to compare the accuracy of the Paprosky Classification of Femoral Bone Loss using plain radiographs and two-dimensional computed tomography (2D CT) images with the femoral defect observed intraoperatively by the surgeon. Methods: There were 14 hip surgeons from the same hospital who classified 80 patients with an indication for revision hip arthroplasty according to Paprosky based on plain radiographs in anteroposterior views of the pelvis and 2D CT images, reconstructed in the axial, coronal, and sagittal planes. We compared this data with the intraoperative findings of femoral bone loss by the same surgeons. Results: The agreement between the radiographic and CT assessment was excellent for femoral bone defects (94% agreement; κ = 0.95; 0.90-0.99). Individually, the radiograph-based classification agreed with the intraoperative classification in 85% of cases (κ = 0.8; 0.70-0.90). The CT-based one had 86% of agreement (κ = 0.84; 0.75-0.93). There was no statistical difference between the methods. Conclusion: The use of 2D CT did not show any benefits in recognizing femoral bone loss by the Paprosky classification compared with radiography. Therefore, the significance of 2D images in planning femoral component revision surgery should be questioned, as it is associated with higher financial costs and greater patient exposure to high radiation levels.