The feasibility of three-dimensional visualization in determining the severity of bone defects in the acetabulum

Introduction. As is known, diffi ulties in revision hip arthroplasty are most often due to the defi cy and quality of bone tissue in the acetabulum. To determine the tactics of surgical treatment and components, various classifi ations of bone defects are used, which are periodically updated or undergo revision and refi ement. However, it must be understood that even using such “convenient” classifi ations, it is not always possible to assess changes in theacetabular region using planar radiographs. To solve and resolve such controversial cases and the possibility of practical application of various classifi ations, it is advisable to use a three-dimensional reconstruction even at the planning stage.Purpose. To determine the role and place of three-dimensional visualization of the pelvic bones in patients with severe defects of the acetabulum according to the classifi ation of A.Gross/K.SalehMaterials and Methods: For this experimental study, a questionnaire was developed, consisting of two blocks: acquaintance with the examinee and direct questions on the assessment of 20 clinical cases. The examinees were asked to assess the state of the acetabulum for limited and unlimited bone defects according to the A.Gross/K.Saleh classifi ation solely on the basis of X-ray examination. Subsequently, we compared the responses of surgeons for each clinical case with the type of defect (contained or uncontained) based on a three-dimensional reconstruction performed by the developer of the questionnaire. Results: The study involved 12 surgeons with different experience in revision surgery. Cohen's Kappa consistency coeffi t in the comparative assessment of X-ray image and three-dimensional visualization between students and developers was equal to 0.111 (95% CI 0.03 - 0.256), between experienced specialists - 0.1538 (95% CI 0.02-0.33), between professionals - 0.3043 (95% CI 0.036-0.576), respectively, which in all cases indicates low results, although it has small statistically insignifi ant differences.Conclusions: Thus, the results of the experimental study revealed an insuffi t understanding of the clinical situation based on planar radiographs (namely, the severity of the bone tissue defect in the acetabular region) and make it expedient to routinely use modern computer technologies in complex cases, namely, three-dimensional visualization.