Pelvic discontinuity in acetabular revisions: does CT scan overestimate it? A comparative study of diagnostic accuracy of 3D-modeling and traditional 3D CT scan

3D CT scan is actually the gold standard for preoperative diagnosis of pelvic discontinuity (PD) in hip revision surgery. Aim of this study was to compare the accuracy of 3D-modeling with traditional and 3D CT scan.

We retrospectively identified 56 patients who underwent total hip arthroplasty revisions with Paprosky Type-3 periacetabular bone defects. Preoperative X-rays, CT scans and 3D-models were blindly reviewed by two orthopedic surgeons to detect possible pelvic discontinuities. Results were compared with surgical notes. Independent sensitivities, specificities, positive predictive values and negative predictive values were calculated for X-rays, CT scan and 3D models. Analysis of interobserver reliability was performed.

Fifty-six patients met inclusion criteria. In nine patients, surgical notes indicated a pelvic discontinuity. On 3D CT scans, PD was identified in 25 cases for observer 1 and in 24 cases for observer 2. Analyzing 3D-models, PD was identified in eleven patients by both observers. The nine patients, with PD reported on the surgical report, were all identified with both the techniques. The specificity of standard 3D CT was 0.66 for observer 1 and 0.68 for observer 2 and increased to 0.96 for both observers with the utilization of 3D-models. The positive predictive value increased from 0.36 (observer 1) and 0.38 (observer 2) with the CT evaluation to 0.82 in the 3D-models evaluation. The analysis of 3D models was characterized by a perfect intraobserver reliability (intraobserver correlation coefficient = 1). The observers showed substantial agreement for PD classification; the kappa values were 0.96 and 0.77, respectively, for CT scan and 3D-model evaluation.

3D-modeling showed higher specificity than traditional and 3D CT scans in identification of PD in Paprosky Type-3 periacetabular bone defects.