Torrealba Rafaela Reis, Castro Maria Isabella Cruz de, Veiga-Santos Phercyles, Almeida Marcelo Felipe, Laett Conrado Torres, Peixoto Lourenço
Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil.
Rev Bras Ortop (Sao Paulo). 2025 Sep 8;60(3):s00451810035. doi: 10.1055/s-0045-1810035. eCollection 2025 Jun.
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.
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.
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.
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.
本研究旨在比较使用骨盆前后位平片和二维计算机断层扫描（2D CT）图像的Paprosky股骨骨丢失分类的准确性与外科医生术中观察到的股骨缺损情况。
来自同一家医院的14位髋关节外科医生，根据骨盆前后位平片以及在轴向、冠状面和矢状面重建的2D CT图像，按照Paprosky方法对80例有髋关节翻修术指征的患者进行分类。我们将这些数据与同组外科医生术中股骨骨丢失的发现进行比较。
对于股骨骨缺损，X线片评估和CT评估之间的一致性非常好（一致性为94%；κ = 0.95；0.90 - 0.99）。单独来看，基于X线片的分类在85%的病例中与术中分类一致（κ = 0.8；0.70 - 0.90）。基于CT的分类一致性为86%（κ = 0.84；0.75 - 0.93）。两种方法之间无统计学差异。
与X线摄影相比，使用2D CT在通过Paprosky分类识别股骨骨丢失方面未显示出任何优势。因此，2D图像在规划股骨部件翻修手术中的意义值得质疑，因为它会带来更高的经济成本以及使患者更多地暴露于高辐射水平。
