Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
The George Washington University School of Medicine, 2300 I Street NW, Washington, DC, 20052, USA.
Arch Orthop Trauma Surg. 2024 Sep;144(9):4267-4273. doi: 10.1007/s00402-024-05524-x. Epub 2024 Sep 23.
Reliability and validity of the Paprosky classification for acetabular bone loss have been debated. Additionally, the relationship between surgeon training level and Paprosky classification accuracy/treatment selection is poorly defined. This study aimed to: (1) evaluate the validity of preoperative Paprosky classification/treatment selection compared to intraoperative classification/treatment selection and (2) evaluate the relationship between training level and intra-rater and inter-rater reliability of preoperative classification and treatment choice.
Seventy-four patients with intraoperative Paprosky types [I (N = 24), II (N = 27), III (N = 23)] were selected. Six raters (Residents (N = 2), Fellows (N = 2), Attendings (N = 2)) independently provided Paprosky classification and treatment using preoperative radiographs. Graders reviewed images twice, 14 days apart. Cohen's Kappa was calculated for (1) inter-rater agreement of Paprosky classification/treatment by training level (2), intra-rater reliability, (3) preoperative and intraoperative classification agreement, and (4) preoperative treatment selection and actual treatment performed.
Inter-rater agreement between raters of the same training level was moderate (K range = 0.42-0.50), and mostly poor for treatment selection (K range = 0.02-0.44). Intra-rater agreement ranged from fair to good (K range = 0.40-0.73). Agreement between preoperative and intraoperative classifications was fair (K range = 0.25-0.36). Agreement between preoperative treatment selections and actual treatments was fair (K range = 0.21-0.39).
Inter-rater reliability of Paprosky classification was poor to moderate for all training levels. Preoperative Paprosky classification showed fair agreement with intraoperative Paprosky grading. Treatment selections based on preoperative radiographs had fair agreement with actual treatments. Further research should investigate the role of advanced imaging and alternative classifications in evaluation of acetabular bone loss.
髋臼骨缺损的 Paprosky 分类的可靠性和有效性一直存在争议。此外，外科医生培训水平与 Paprosky 分类准确性/治疗选择之间的关系也尚未明确。本研究旨在：(1) 评估术前 Paprosky 分类/治疗选择与术中分类/治疗选择的有效性；(2) 评估培训水平与术前分类和治疗选择的内部和外部评估者之间的可靠性的关系。
选择 74 例术中 Paprosky 类型[I 型（N=24）、II 型（N=27）、III 型（N=23）]的患者。6 名评估者（住院医师（N=2）、研究员（N=2）、主治医生（N=2））分别根据术前 X 线片提供 Paprosky 分类和治疗方法。评估者两次查看图像，间隔 14 天。计算（1）不同培训水平的 Paprosky 分类/治疗的评估者之间的（2）内部评估者的可靠性、（3）术前和术中分类的一致性以及（4）术前治疗选择和实际治疗的一致性的 Cohen's Kappa。
同培训水平的评估者之间的评估者间一致性为中度（K 范围=0.42-0.50），治疗选择的一致性主要较差（K 范围=0.02-0.44）。内部评估者的一致性范围为 0.40-0.73。术前和术中分类之间的一致性为中度（K 范围=0.25-0.36）。术前治疗选择与实际治疗的一致性为中度（K 范围=0.21-0.39）。
所有培训水平的 Paprosky 分类的评估者间可靠性为差到中度。术前 Paprosky 分类与术中 Paprosky 分级具有中等一致性。基于术前 X 线片的治疗选择与实际治疗具有中等一致性。应进一步研究高级影像学和替代分类在评估髋臼骨缺损中的作用。
