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Paprosky I defect
0%
2/1022
Paprosky IIA defect
1%
7/1022
Paprosky IIB defect
6%
59/1022
Paprosky IIIA defect
11%
114/1022
Paprosky IIIB defect
81%
823/1022
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Paprosky IIIB defects are defined as "up and in" defects and are commonly associated with pelvic discontinuity. Further evaluation with CT angiogram is recommended to identify the relationship between the implants and intrapelvic vasculature. The Paprosky classification is widely used as a means of describing acetabular defects and guiding treatment. Type I defects are described as having minimal bone loss and primary acetabular components can be used. Type II defects (A - superior and medial defect, B - uncontained defect and C - medial defect) have notable bone loss, but at least 50% of a hemispherical acetabular component would ultimately make contact with host bone. Type III defects are more sizable defects, either IIIA "up and out" or IIIB "up and in". With IIIB defects, pelvic discontinuity is a major concern and evaluation of remaining bone as well as the relationship between intrapelvic components and vascular structures is warranted via a CT angiogram. Gouin et al review a subperitoneal approach in revision arthroplasty for acetabular component protrusion. They report on 19 patients out of 260 revisions in which this approach was needed. Of the 19, 4 were utilized because of a vascular complication that was identified preoperatively. They conclude that a CT angiogram followed by a subperitoneal approach should be used in patients with intrapelvic components. Paprosky et al review an acetabular defect classification and surgical reconstruction in revision arthroplasty. They report on 147 cemented acetabular components that were revised to press fit hemispherical cups. They then graded acetabular defects I-III as described above. They conclude that the size, orientation, and method of fixation of the allografts play an important role in the integrity of structural allografts, while adequate remaining host-bone must be present to ensure bone ingrowth. Illustration A is a schematic depicting the Paprosky classification for acetabular bone loss. Incorrect Answers: Answers 1-4: Paprosky IIIB defects are the only type that cross medially in to the pelvis. CT angiogram is often used to evaluate host bone as well as the proximity to the iliac vessels.
3.6
(5)
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