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Introduction <p>The complex field of revision knee arthroplasty displays a lack of standardized, intuitive pre- and intraoperative assessment of bone defects. In clinical practice revision surgeries are a common sight presenting with increasingly complex cases of bone loss and ligamentary dysfunction. To address these issues the Knee Defect Classification (KDC) is introduced to offer a reliable, reproducible and an intuitive classification system with a clear therapeutic guideline.</p> Materials and methods <p>Reliability was evaluated through comparison between intraoperative findings and preoperative gradings of 218 patients. To account for reproducibility inter- and intra-rater agreement was assessed.</p> Results <p>The mean agreement between intraoperative and radiographic grading of femoral and tibial defects was evaluated with a Cohens kappa of 0.79, representing a good agreement. For interrater reliability a mean Fleiss kappa of 0.71 could be evaluated for femoral and tibial defects falling into the good agreement range. In the subgroup analysis femoral defects presented with a Fleiss kappa of 0.652 ± 0.026 (good agreement), while tibial defects presented with a Fleiss kappa of 0.768 ± 0.024 (good agreement). For intrarater reliability a mean Cohens kappa was evaluated at 0.78 indicating good agreement.</p> Conclusion <p>The KDC is a reliable and reproducible classification system. Through its structured design it facilitates intuitive use and allows for consistent preoperative planning and intraoperative guidance. A therapeutic algorithm is provided based on a review of the literature in combination with expert opinion.</p>

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Bone defects in knee revision arthroplasty—a therapy-oriented classification

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月29日

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  • Max Jaenisch,
  • Elias Hoven,
  • Martin Gathen,
  • Frank Sebastian Fröschen,
  • Adnan Kasapovic,
  • Charlotte Rommelspacher,
  • Andreas Christian Strauß,
  • Dieter Christian Wirtz

摘要

Introduction

The complex field of revision knee arthroplasty displays a lack of standardized, intuitive pre- and intraoperative assessment of bone defects. In clinical practice revision surgeries are a common sight presenting with increasingly complex cases of bone loss and ligamentary dysfunction. To address these issues the Knee Defect Classification (KDC) is introduced to offer a reliable, reproducible and an intuitive classification system with a clear therapeutic guideline.

Materials and methods

Reliability was evaluated through comparison between intraoperative findings and preoperative gradings of 218 patients. To account for reproducibility inter- and intra-rater agreement was assessed.

Results

The mean agreement between intraoperative and radiographic grading of femoral and tibial defects was evaluated with a Cohens kappa of 0.79, representing a good agreement. For interrater reliability a mean Fleiss kappa of 0.71 could be evaluated for femoral and tibial defects falling into the good agreement range. In the subgroup analysis femoral defects presented with a Fleiss kappa of 0.652 ± 0.026 (good agreement), while tibial defects presented with a Fleiss kappa of 0.768 ± 0.024 (good agreement). For intrarater reliability a mean Cohens kappa was evaluated at 0.78 indicating good agreement.

Conclusion

The KDC is a reliable and reproducible classification system. Through its structured design it facilitates intuitive use and allows for consistent preoperative planning and intraoperative guidance. A therapeutic algorithm is provided based on a review of the literature in combination with expert opinion.