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

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cam.issuedOnline2022-05-13
dc.contributor.authorLeong, Justin WY
dc.contributor.authorSinghal, Rohit
dc.contributor.authorWhitehouse, Michael R
dc.contributor.authorHowell, Jonathan R
dc.contributor.authorHamer, Andrew
dc.contributor.authorKhanduja, Vikas
dc.contributor.authorBoard, Tim N
dc.contributor.authorBHS RHCC expert panel.
dc.contributor.orcidLeong, Justin WY [0000-0002-7571-7204]
dc.date.accessioned2022-06-14T01:02:42Z
dc.date.available2022-06-14T01:02:42Z
dc.date.issued2022-05
dc.date.updated2022-06-14T01:02:41Z
dc.description.abstractAIMS: 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.
dc.identifier.doi10.17863/CAM.85458
dc.identifier.eissn2633-1462
dc.identifier.issn2633-1462
dc.identifier.other35549448
dc.identifier.otherPMC9134833
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/338049
dc.languageeng
dc.language.isoeng
dc.publisherBritish Editorial Society of Bone & Joint Surgery
dc.publisher.urlhttp://dx.doi.org/10.1302/2633-1462.35.bjo-2022-0022.r1
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.sourcenlmid: 101770336
dc.sourceessn: 2633-1462
dc.subjectAnesthesiologists
dc.subjectBone loss
dc.subjectDelphi methodology
dc.subjectDelphi process
dc.subjectDislocation
dc.subjectHip
dc.subjectInfection
dc.subjectPeriprosthetic fracture
dc.subjectRevision Hip Complexity Classification
dc.subjectRevision total hip arthroplasty
dc.subjectacetabulum
dc.subjectbone loss
dc.subjectdebridement, antibiotics, and implant retention
dc.subjectfemur
dc.subjectmedical comorbidities
dc.subjectperiprosthetic fractures
dc.subjectrevision hip surgery
dc.titleDevelopment of the Revision Hip Complexity Classification using a modified Delphi technique.
dc.typeArticle
prism.endingPage431
prism.issueIdentifier5
prism.publicationNameBone Jt Open
prism.startingPage423
prism.volume3
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1302/2633-1462.35.BJO-2022-0022.R1

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