Intraobserver and interobserver reliability of Catterall, Herring, Salter–Thompson and Stulberg classification systems in Perthes disease

Aims The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes’ disease. Methods A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. At the five- and 21-year follow-up, the femoral heads were classified using a modified three-group Stulberg classification (round, ovoid, or flat femoral head). Further radiological endpoints at long-term follow-up were osteoarthritis (OA) of the hip and the requirement for total hip arthroplasty (THA). Results There were 71 males (81%) and 17 females. A total of 13 patients had bilateral Perthes’ disease; thus 101 hips were analyzed. At five-year follow-up, 37 hips were round, 38 ovoid, and 26 flat. At that time, 66 hips (65%) were healed and 91 (90%) were skeletally immature. At long-term follow-up, when the mean age of the patients was 28 years (24 to 34), 20 hips had an unsatisfactory outcome (seven had OA and 13 had required THA). There was a strongly significant association between the modified Stulberg classification applied atfive-year follow-up and an unsatisfactory outcome at long-term follow-up (p < 0.001). Between the five- and 21-year follow-up, 67 hips (76%) stayed in their respective modified Stulberg group, indicating a strongly significant association between the Stulberg classifications at these follow-ups (p < 0.001). Conclusion The modified Stulberg classification is a strong predictor of long-term radiological outcome in patients with Perthes’ disease. It can be applied at the healing stage, which is usually reached five years after the diagnosis is made and before skeletal maturity. Cite this article: Bone Joint J 2021;103-B(12):1815–1820.

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Correlations between radiological classification systems and confirmed cartilage loss in severe knee osteoarthritis

The Bone & Joint Journal ◽

10.1302/0301-620x.102b3.bjj-2019-0337.r1 ◽

2020 ◽

Vol 102-B (3) ◽

pp. 301-309 ◽

Cited By ~ 4

Author(s):

Oisin J. F. Keenan ◽

George Holland ◽

Julian F. Maempel ◽

John F. Keating ◽

Chloe E. H. Scott

Keyword(s):

Knee Osteoarthritis ◽

Correlation Coefficient ◽

Interobserver Reliability ◽

Severe Disease ◽

Intraclass Correlation ◽

Lateral Compartment ◽

Classification Systems ◽

Medial Compartment ◽

Cartilage Loss ◽

Radiological Classification

Aims Although knee osteoarthritis (OA) is diagnosed and monitored radiologically, actual full-thickness cartilage loss (FTCL) has rarely been correlated with radiological classification. This study aims to analyze which classification system correlates best with FTCL and to assess their reliability. Methods A prospective study of 300 consecutive patients undergoing unilateral total knee arthroplasty (TKA) for OA (mean age 69 years (44 to 91; standard deviation (SD) 9.5), 178 (59%) female). Two blinded examiners independently graded preoperative radiographs using five common systems: Kellgren-Lawrence (KL); International Knee Documentation Committee (IKDC); Fairbank; Brandt; and Ahlbäck. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Intraoperatively, anterior cruciate ligament (ACL) status and the presence of FTCL in 16 regions of interest were recorded. Radiological classification and FTCL were correlated using the Spearman correlation coefficient. Results Knees had a mean of 6.8 regions of FTCL (SD 3.1), most common medially. The commonest patterns of FTCL were medial ± patellofemoral (143/300, 48%) and tricompartmental (89/300, 30%). ACL status was associated with pattern of FTCL (p = 0.023). All radiological classification systems demonstrated moderate ICC, but this was highest for the IKDC: whole knee 0.68 (95% confidence interval (CI) 0.60 to 0.74); medial compartment 0.84 (95% CI 0.80 to 0.87); and lateral compartment 0.79 (95% CI 0.73 to 0.83). Correlation with actual FTCL was strongest for Ahlbäck (Spearman rho 0.27 to 0.39) and KL (0.30 to 0.33) systems, although all systems demonstrated medium correlation. The Ahlbäck score was the most discriminating in severe knee OA. Osteophyte presence in the medial compartment had high positive predictive value (PPV) for FTCL, but not in the lateral compartment. Conclusion The Ahlbäck and KL systems had the highest correlation with confirmed cartilage loss at TKA. However, the IKDC system displayed the best interobserver reliability, with favourable correlation with FTCL in medial and lateral compartments, although it was less discriminating in more severe disease. Cite this article: Bone Joint J 2020;102-B(3):301–309

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Interobserver Reliability in the Interpretation of Radiologic Signs in Legg-Calvé-Perthes Disease

Journal of Pediatric Orthopaedics B ◽

10.1097/01202412-200201000-00003 ◽

2002 ◽

Vol 11 (1) ◽

pp. 10-14

Author(s):

Benoit de Billy ◽

Jean François Viel ◽

Elisabeth Monnet ◽

Emmanuelle Garnier ◽

Didier Aubert

Keyword(s):

Interobserver Reliability ◽

Perthes Disease

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Advanced containment methods for Legg-Calvé-Perthes disease: triple pelvic osteotomy versus Chiari osteotomy

Hip International ◽

10.5301/hipint.5000569 ◽

2017 ◽

Vol 28 (3) ◽

pp. 297-301 ◽

Cited By ~ 4

Author(s):

Olivier Rosello ◽

Federico Solla ◽

Ioana Oborocianu ◽

Edouard Chau ◽

Tony ElHayek ◽

...

Keyword(s):

Pelvic Osteotomy ◽

Wilcoxon Test ◽

Perthes Disease ◽

Harris Hip Score ◽

Salter Osteotomy ◽

Stulberg Classification ◽

And Performance ◽

And Function ◽

Chiari Osteotomy

Introduction: The goal of intervention in Legg-Calvé-Perthes disease (LCPD) is to prevent femoral head deformation by containing the head within the acetabulum. Currently, surgical containment methods are the mainstay of treatment, and pelvic osteotomies have been shown to be successful. They include triple pelvic osteotomy (TPO), Salter osteotomy, Chiari osteotomy and shelf procedure. The purpose of this study was to compare clinical and radiologic results for Chiari osteotomy and TPO in LCPD. Methods: 29 children treated between 1980 and 2010 for LCPD in 2 centres were reviewed. 19 underwent TPO, and 10, Chiari osteotomy. Two independent observers assessed sequential radiographs and medical data. Each hip was preoperatively classed by clinical data, Catteral, Herring and Salter-Thompson classification, centre-edge angle (CE), and acetabular index (AI). The 2 groups were first tested for their comparability. After surgery the hips were classified by Stulberg classification, CE, AI, Harris Hip Score (HHS) and performance of further surgery. Chiari osteotomy and TPO have been secondary compared on these data by Wilcoxon test. Results: Average follow-up was 4.2 years. The 2 groups were comparable before surgery. At first and last follow-up examination, statistically significantly superior results in patients with TPO regarding Stulberg classification (p = 0.01), AI (p = 0.002), pain (p = 0.02) and function (p = 0.01) in the HHS score were found. No differences were noticed concerning CE angle. Conclusions: In our series, TPO provided better radiologic and clinical outcomes compared to Chiari osteotomy, specially concerning the final Stulberg classification. We concluded that TPO should be preferred when indicated.

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Interobserver Reliability of the Young-Burgess and Tile Classification Systems for Fractures of the Pelvic Ring

Journal of Orthopaedic Trauma ◽

10.1097/bot.0b013e31817440cf ◽

2008 ◽

Vol 22 (6) ◽

pp. 379-384 ◽

Cited By ~ 45

Author(s):

Henry Koo ◽

Mike Leveridge ◽

Charles Thompson ◽

Rad Zdero ◽

Mohit Bhandari ◽

...

Keyword(s):

Pelvic Ring ◽

Interobserver Reliability ◽

Classification Systems

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Interobserver Reliability of 2 Classification Systems for Open Hand Fractures

Hand ◽

10.1177/1558944719840738 ◽

2019 ◽

pp. 155894471984073

Author(s):

William J. Warrender ◽

Christopher J. Lucasti ◽

Asif Ilyas

Keyword(s):

Interobserver Reliability ◽

Classification Systems ◽

Hand Fractures

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Predicting epiphyseal stability of slipped capital femoral epiphysis with preoperative CT imaging

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190123 ◽

2020 ◽

Vol 14 (1) ◽

pp. 68-75

Author(s):

Megan E. Fischer-Colbrie ◽

Craig R. Louer ◽

James D. Bomar ◽

Peter Hahn ◽

Eric W. Edmonds ◽

...

Keyword(s):

Classification System ◽

Evaluation Method ◽

Interobserver Reliability ◽

Slipped Capital Femoral Epiphysis ◽

Ct Imaging ◽

Classification Systems ◽

Level Of Evidence ◽

Ct Evaluation ◽

Preoperative Ct ◽

Ct Classification

Background We analyzed preoperative CT scans of hips with slipped capital femoral epiphysis (SCFE) for characteristics that could be predictive of intraoperative epiphyseal stability and developed a set of imaging criteria for stable and unstable SCFE. We then compared this grading system with the Loder classification. Methods We reviewed preoperative CT imaging to develop a SCFE stability classification system. Three orthopaedic surgeons used the classification system to grade stability on a series of SCFE hips. Kappa was used to evaluate intra- and interobserver reliability among the observers. A series of SCFE hips treated with open procedures in which intraoperative stability was determined under direct visualization was evaluated. Intraoperative stability was compared with stability ratings as determined by the CT classification system and the Loder classification system. Results Interobserver reliability among our three observers was κ = 0.823 (95% confidence interval (CI) 0.414 to 1.0; p < 0.001). Intraobserver reliability was κ = 0.901 (95% CI 0.492 to 1.31; p < 0.001). In all, 27 hips were used in the comparison of intraoperative stability with the Loder and CT classification systems. CT-predicted stability exhibited 78% concordance with intraoperative stability. The sensitivity and specificity of CT-predicted stability was 75% and 82%, respectively, versus Loder sensitivity of 69% and specificity of 91%. Conclusion The CT evaluation method provided is easy to use and can help to improve the accuracy in determining preoperative epiphyseal stability, which may lead to improved treatment outcomes for this population. Level of Evidence III

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Intraobserver and Interobserver Reliability of Three Classification Systems for Hallux Rigidus

Journal of the American Podiatric Medical Association ◽

10.7547/16-126 ◽

2018 ◽

Vol 110 (3) ◽

Author(s):

Peter Pham ◽

Sarita Dillard ◽

Christina Schilero ◽

Sharon Chiang

Keyword(s):

Interobserver Reliability ◽

Intraclass Correlation ◽

Plain Radiograph ◽

Hallux Rigidus ◽

Classification Systems ◽

Foot And Ankle ◽

Intrarater Reliability ◽

Single Measure ◽

The Mean ◽

Prognostic Implications

Background There are more than ten classification systems currently used in the staging of hallux rigidus. This results in confusion and inconsistency with radiographic interpretation and treatment. The reliability of hallux rigidus classification systems has not yet been tested. We sought to evaluate the intraobserver and interobserver reliabilities of three commonly used classifications for hallux rigidus. Methods Twenty-one plain radiograph sets were presented to ten American College of Foot and Ankle Surgeons board-certified foot and ankle surgeons. Each physician classified each radiograph based on clinical experience and knowledge according to the Regnauld, Roukis, and Hattrup and Johnson classification systems. The two-way mixed single-measure consistency intraclass correlation coefficient was used to calculate intrarater and interrater reliabilities. Results The mean ± SD intrarater reliability of individual sets for the Roukis (0.62 ± 0.19) and Hattrup and Johnson (0.62 ± 0.28) classification systems was fair to good and for the Regnauld system bordered between fair to good and poor (0.43 ± 0.24). The interrater reliability of the mean classification was excellent for all three classification systems. Conclusions Reliable and reproducible classification systems are essential for treatment and prognostic implications in hallux rigidus. Herein, the Roukis classification system had the best intrarater reliability. Although there are various classification systems for hallux rigidus, the present results indicate that the three classification systems evaluated show reliability and reproducibility.

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