System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Epublish

PubMed: 42409371 DOI: 10.1302/2633-1462.77.BJO-2026-0041.R1

The Reconstructive Pelvic Anatomy classification system : a valid and reliable classification system for pelvic reconstruction.

Bone Jt Open 7(7):871-881

Authors: William J J Collins, Daniel Franks, Ian A Harris, Verinder S Sidhu, Maurice Guzman, Paul D Stalley, Joshua Zadro, Kate Alexander, Philip Hay, Kai Cheng, Scott Sommerville, Luke Johnson, Richard Carey Smith, Demien Broekhuis, Matthew Broadhead, Richard Boyle

Affiliations

  • University of Sydney, Sydney, Australia. Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
  • Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
  • School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia.
  • Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
  • Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.
  • Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.
  • Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia. Integrated Prosthetics and Reconstruction, Chris O'Brien Lifehouse, Sydney, Australia.
  • Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia.
  • Flinders University, College of Medicine & Public Health, Adelaide, Australia.
  • South Australian Bone & Soft Tissue Tumour Unit, Adelaide, Australia.
  • Department of Orthopaedics, Sir Charles Gairdner Hospital, Perth, Australia.
  • Perth Orthopaedic & Sports Medicine Centre, Perth, Australia.
  • Faculty of Medicine, The University of Western Australia, Perth, Australia.
  • Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
  • Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia. University of New South Wales Rural Clinical School, Wagga Wagga, Australia.
  • School of Medicine, University of Notre Dame, Sydney, Australia.

Abstract

AIMS

Pelvic reconstruction in the setting of significant bone loss has become increasingly complex, with advancements such as custom 3D-printed prostheses now used in both large oncological resections and revision total hip arthroplasty (rTHA) with massive bone loss. Surgeons must consider how to best reconstruct the pelvis to optimize patient outcomes. The Reconstructive Pelvic Anatomy (RPA) classification system is proposed to aid in communication, reconstructive planning, and developing research cohorts suitable for modern pelvic reconstructions. This study aimed to 1) describe the development of the RPA classification as a novel classification system for pelvic reconstruction; 2) demonstrate the content and construct validity of the system; and 3) investigate its interobserver and intraobserver agreement.

METHODS

A group of orthopaedic surgeons and researchers, based in Sydney, Australia, developed the system's four domains, which together form the overall classification. A total of 23 pelvic reconstruction surgeons provided an assessment of each domain's clarity and relevance, producing an Item-Content Validity Index (I-CVI). They then applied the classification to the surgical plan and postoperative radiograph of 20 pelvic reconstructions twice, at a minimum of two weeks apart. Construct validity was assessed by agreement between observers and authors. Interobserver and intraobserver agreement was assessed using the kappa statistic.

RESULTS

A total of 23 surgeons completed the assessment of content validity, and 18 surgeons completed both surveys. Each domain demonstrated content validity for both relevance and clarity (I-CVI > 0.78). Authors and observers had moderate agreement on the classification supporting construct validity (k = 0.6) with a median agreement of 90% for individual domains. Interobserver agreement was moderate overall (k = 0.54), with individual domains having substantial or better agreement (k = 0.73 to 0.82) except for anterior fixation (k = 0.57). Intraobserver agreement of individual domains was substantial or almost perfect (k = 0.76 to 0.84) with moderate agreement for the overall classification (k = 0.6).

CONCLUSION

This study establishes the content and construct validity of the RPA classification system as a novel classification system for pelvic reconstruction, and its reliability to support its use as a communicative tool, and in research and surgical planning.

MeSH

Classification, Research, Anatomy, Surgeons