A influência da tomografia computadorizada no planejamento pré-operatório da revisão de artroplastia do quadril – Componente femoral

Resumo

Objetivo

Este estudo teve como objetivo comparar a acurácia da Classificação de Paprosky de Perda Óssea Femoral utilizando radiografias simples e imagens de tomografia computadorizada bidimensional (TC-2D), com o defeito femoral observado no intraoperatório pelo cirurgião.

Métodos

Um total de 80 pacientes com indicação para a revisão de artroplastia do quadril foram classificados de acordo com Paprosky, por 14 cirurgiões do quadril do mesmo hospital, com base em radiografias simples em anteroposterior da pelve e posteriormente baseadas em TC-2D, reconstruídas nos planos axial, coronal e sagital. Esses dados foram comparados com os achados de perda óssea femoral no intraoperatório pelos mesmos cirurgiões.

Resultados

A concordância entre a avaliação feita por radiografia e TC é excelente para o defeito ósseo femoral (94% de concordância; κ = 0,95; 0,90–0,99). Individualmente, a classificação feita de acordo com a radiografia concorda com a classificação intraoperatória em 85% dos casos (κ = 0,8; 0,70–0,90). A feita com base na TC tem 86% de concordância (κ = 0,84; 0,75–0,93). Não houve diferença estatística entre os métodos.

Conclusão

O uso de TC-2D não mostrou benefícios no reconhecimento da perda óssea femoral pela classificação de Paprosky em comparação com a radiografia. Portanto, deve-se questionar a importância das imagens 2D no planejamento da cirurgia de revisão do componente femoral, visto que se associa com maior custo financeiro e à maior exposição do paciente a níveis elevados de radiação.

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Palavras-chave

artroplastia de quadril - cirurgia de revisão - cirurgia ortopédica - tomografia computadorizada

Keywords

arthroplasty, replacement, hip - revision surgery - surgery, orthopedic - tomography, x-ray computed

Trabalho desenvolvido no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brasil.

Publication History

Received: 05 June 2024

Accepted: 26 April 2025

Article published online:
08 September 2025

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