This Classifications In Brief article describes the Paprosky system for categorizing femoral bone loss in revision THA. It defines five defect types by location and severity of bone loss, links each to a treatment algorithm for implant selection, and reviews reliability and validity data across studies and experience levels.
The single number to internalize before any femoral revision: if you have ≥4 cm of intact diaphysis (Type IIIA), an extensively porous-coated stem gives 95% survivorship past 13 years. Drop below 4 cm (Type IIIB), and those same stems loosen 21% of the time.
Treat the preoperative Paprosky type as a working hypothesis, not a confirmed diagnosis. Radiographs underestimate bone loss in 1 in 8 cases. If your films suggest Type IIIA, have a tapered splined stem and a proximal femoral replacement on the back table before you open.
Reliability data demands humility: even experienced arthroplasty surgeons agree only about 60% of the time preoperatively. Use full-length orthogonal femoral radiographs, build pattern recognition through exposure to revision cases, and always be prepared for a more complex problem than your imaging suggested.
The Della Valle and Paprosky algorithmic approach published in JBJS 2003 operationalized this classification into the implant-selection framework still used worldwide today.
This Classifications In Brief article describes the Paprosky system for categorizing femoral bone loss in revision THA. It defines five defect types by location and severity of bone loss, links each to a treatment algorithm for implant selection, and reviews reliability and validity data across studies and experience levels.
The single number to internalize before any femoral revision: if you have ≥4 cm of intact diaphysis (Type IIIA), an extensively porous-coated stem gives 95% survivorship past 13 years. Drop below 4 cm (Type IIIB), and those same stems loosen 21% of the time.
Treat the preoperative Paprosky type as a working hypothesis, not a confirmed diagnosis. Radiographs underestimate bone loss in 1 in 8 cases. If your films suggest Type IIIA, have a tapered splined stem and a proximal femoral replacement on the back table before you open.
Reliability data demands humility: even experienced arthroplasty surgeons agree only about 60% of the time preoperatively. Use full-length orthogonal femoral radiographs, build pattern recognition through exposure to revision cases, and always be prepared for a more complex problem than your imaging suggested.
The Della Valle and Paprosky algorithmic approach published in JBJS 2003 operationalized this classification into the implant-selection framework still used worldwide today.