The role of three-dimensional visualization in revision hip arthroplasty

Introduction Preoperative assessment of the acetabular bone defect location and size is an important stage in the preparation for revision hip arthroplasty. It is generally recognized that radiographs are not sensitive enough to assess peri-implant osteolysis, and therefore difficulties arise in determining the true dimensions of acetabular defects and in choosing the optimal surgical tactics. Purpose To determine the effect of three-dimensional visualization of the pelvic bones in patients with significant acetabular defects on the evaluation of the defect and the choice of surgical tactics at the stage of planning operations. Materials and methods For our study, a questionnaire was compiled, in which the surgeon’s experience in performing revision interventions in the hip joint was evaluated and it was proposed to consistently evaluate 20 clinical cases based on radiographs, and then on three-dimensional reconstruction. Each clinical case was asked to be evaluated for defect type according to the Paprosky classification, and also to choose one of the proposed options of surgical techniques. Results After comparing the data obtained by viewing the radiographs with the data obtained after evaluating the three-dimensional reconstruction of the defect, the Kappa consistency coefficient for the type of defect according to the Paprosky classification was 0.10 (95 % confidence interval 0.05-0.26), and for the choice of surgical tactics was equal to 0.08 (95 % confidence interval 0.01-0.15). It indicates that surgeons changed their minds in a significant number of cases. Conclusion The results of the study show the need for additional studies, in particular three-dimensional visualization, as part of the preoperative planning of revision arthroplasty, especially in cases of complex acetabular defects.