Della Valle and Paprosky describe a five-type classification of femoral bone loss in revision THA, stratified by metaphyseal integrity, diaphyseal bone remaining, and isthmus quality. Each type is paired with a specific reconstructive algorithm. The classification is validated in 71 consecutive femoral revisions with a minimum 8-year follow-up.
Walk into any revision hip case and the first question is: how much femur do you have to work with? Before this classification, implant selection was largely experiential. The Paprosky system made it algorithmic.
The single most testable fact from this paper: when you measure less than 4 cm of intact diaphysis on the preoperative radiograph, you are dealing with a Type IIIB defect. A cylindrical cementless stem will fail half the time. Plan for a modular fluted tapered stem from the start.
For Type IV defects, no cementless stem works reliably. The reconstructive decision then shifts to patient age and cortical tube integrity: impaction grafting if the tube is intact, allograft-prosthesis composite in younger patients, proximal femoral replacement in the elderly.
This paper is why the Paprosky classification appears on every revision THA preoperative template and in every hip reconstruction fellowship curriculum worldwide.
Della Valle and Paprosky describe a five-type classification of femoral bone loss in revision THA, stratified by metaphyseal integrity, diaphyseal bone remaining, and isthmus quality. Each type is paired with a specific reconstructive algorithm. The classification is validated in 71 consecutive femoral revisions with a minimum 8-year follow-up.
Walk into any revision hip case and the first question is: how much femur do you have to work with? Before this classification, implant selection was largely experiential. The Paprosky system made it algorithmic.
The single most testable fact from this paper: when you measure less than 4 cm of intact diaphysis on the preoperative radiograph, you are dealing with a Type IIIB defect. A cylindrical cementless stem will fail half the time. Plan for a modular fluted tapered stem from the start.
For Type IV defects, no cementless stem works reliably. The reconstructive decision then shifts to patient age and cortical tube integrity: impaction grafting if the tube is intact, allograft-prosthesis composite in younger patients, proximal femoral replacement in the elderly.
This paper is why the Paprosky classification appears on every revision THA preoperative template and in every hip reconstruction fellowship curriculum worldwide.