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. 2022 May;3(5):423-431.
doi: 10.1302/2633-1462.35.BJO-2022-0022.R1.

Development of the Revision Hip Complexity Classification using a modified Delphi technique

Justin W Y Leong  1 , Rohit Singhal  2 , Michael R Whitehouse  3   4 , Jonathan R Howell  5 , Andrew Hamer  6 , Vikas Khanduja  7 , Tim N Board  2 ; BHS RHCC expert panel.
Affiliations

Development of the Revision Hip Complexity Classification using a modified Delphi technique

Justin W Y Leong et al. Bone Jt Open. 2022 May.

Abstract

Aims: The aim of this modified Delphi process was to create a structured Revision Hip Complexity Classification (RHCC) which can be used as a tool to help direct multidisciplinary team (MDT) discussions of complex cases in local or regional revision networks.

Methods: The RHCC was developed with the help of a steering group and an invitation through the British Hip Society (BHS) to members to apply, forming an expert panel of 35. We ran a mixed-method modified Delphi process (three rounds of questionnaires and one virtual meeting). Round 1 consisted of identifying the factors that govern the decision-making and complexities, with weighting given to factors considered most important by experts. Participants were asked to identify classification systems where relevant. Rounds 2 and 3 focused on grouping each factor into H1, H2, or H3, creating a hierarchy of complexity. This was followed by a virtual meeting in an attempt to achieve consensus on the factors which had not achieved consensus in preceding rounds.

Results: The expert group achieved strong consensus in 32 out of 36 factors following the Delphi process. The RHCC used the existing Paprosky (acetabulum and femur), Unified Classification System, and American Society of Anesthesiologists (ASA) classification systems. Patients with ASA grade III/IV are recognized with a qualifier of an asterisk added to the final classification. The classification has good intraobserver and interobserver reliability with Kappa values of 0.88 to 0.92 and 0.77 to 0.85, respectively.

Conclusion: The RHCC has been developed through a modified Delphi technique. RHCC will provide a framework to allow discussion of complex cases as part of a local or regional hip revision MDT. We believe that adoption of the RHCC will provide a comprehensive and reproducible method to describe each patient's case with regard to surgical complexity, in addition to medical comorbidities that may influence their management. Cite this article: Bone Jt Open 2022;3(5):423-431.

Keywords: Anesthesiologists; Bone loss; Delphi methodology; Delphi process; Dislocation; Hip; Infection; Periprosthetic fracture; Revision Hip Complexity Classification; Revision total hip arthroplasty; acetabulum; bone loss; debridement, antibiotics, and implant retention; femur; medical comorbidities; periprosthetic fractures; revision hip surgery.

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Figures

Fig. 1
Fig. 1
Top ten factors that experts considered important in governing complexity of revision hip arthroplasty.
Fig. 2
Fig. 2
Top three factors deemed important for complexity.
Fig. 3
Fig. 3
Final Revision Hip Complexity Classification (RHCC). American Society of Anesthesiologists (ASA) ≥ 3 adds * to final classification grade. The highest classification of any individual element is the overall grade. Possible overall grades are: H1, H1*, H2, H2*, H3, H3*. DAIR, debridement, antibiotics, and implant retention; PFR, proximal femoral replacement; TFR, total femoral replacement; UCS, Unified Classification System.
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