Limited Intraobserver and Interobserver Reliability for the Common Measures of Hip Joint Congruency Used in Dysplasia

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Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314740/

Abstract

Background

A congruent hip frequently is cited in the literature as a prerequisite for performing a reconstructive pelvic osteotomy for hip dysplasia. The designation as congruent is important as incongruent joints generally are regarded as requiring a salvage-type procedure. Several measures of congruency are described in the literature, but it is unclear whether these measures are reliable.

Questions/purposes

We therefore evaluated the intraobserver and interobserver reliabilities of three measures of hip congruency in patients with mild to severe dysplasia.

Methods

We selected radiographs of 30 skeletally mature patients with symptomatic hip dysplasia who were potential candidates for a periacetabular osteotomy. All radiographs were rated by six reviewers on two occasions. Reviewers were shown a series of AP and von Rosen views of either the symptomatic hip or the contralateral side and asked to rate congruency using two previously published measures – the classifications of Yasunaga et al. and Okano et al. The reviewers also were asked to determine whether the hip was congruent based on their subjective opinion (yes/no). The radiographs were reviewed and measurements were repeated 1 month later. Kappa analysis was performed to determine intraobserver and interrater reliabilities between and among individual raters, respectively.

Results

Using the classifications of Yasunaga et al. and Okano et al., we found intraobserver reliability kappa values of 0.43 and 0.37, respectively and interobserver reliability values of 0.18 and 0.25, respectively. The intraobserver reliability of a subjective opinion of yes/no response was 0.74 while the interobserver reliability was 0.21.

Conclusions

When evaluating a spectrum of hip dysplasia, commonly used measures of hip congruency have low intraobserver and interobserver relclassifications of Yasunaga et al. and Okano et al. Interobserver reliability for all three methods was low. New radiographic parameters to consistently identify congruency will be helpful for evaluating the preoperative indications for reconstructive osteotomy.

Clinical Relevance

Hip congruency has long been cited as a requirement for a reconstructive pelvic osteotomy, but based on the above findings, there is no clear agreement regarding what comprises a congruent joint. Thus, better criteria are needed to assess preoperative hip congruency to determine the role of congruency in patient outcomes after surgery for hip dysplasia.
Keywords: 

Clin Orthop Relat Res. May 2012; 470(5): 1414–1420.
Published online Nov 29, 2011. doi:  10.1007/s11999-011-2136-z
PMCID: PMC3314740

Limited Intraobserver and Interobserver Reliability for the Common Measures of Hip Joint Congruency Used in Dysplasia

This article has been cited by other articles in PMC.

Abstract

Background

A congruent hip frequently is cited in the literature as a prerequisite for performing a reconstructive pelvic osteotomy for hip dysplasia. The designation as congruent is important as incongruent joints generally are regarded as requiring a salvage-type procedure. Several measures of congruency are described in the literature, but it is unclear whether these measures are reliable.

Questions/purposes

We therefore evaluated the intraobserver and interobserver reliabilities of three measures of hip congruency in patients with mild to severe dysplasia.

Methods

We selected radiographs of 30 skeletally mature patients with symptomatic hip dysplasia who were potential candidates for a periacetabular osteotomy. All radiographs were rated by six reviewers on two occasions. Reviewers were shown a series of AP and von Rosen views of either the symptomatic hip or the contralateral side and asked to rate congruency using two previously published measures – the classifications of Yasunaga et al. and Okano et al. The reviewers also were asked to determine whether the hip was congruent based on their subjective opinion (yes/no). The radiographs were reviewed and measurements were repeated 1 month later. Kappa analysis was performed to determine intraobserver and interrater reliabilities between and among individual raters, respectively.

Results

Using the classifications of Yasunaga et al. and Okano et al., we found intraobserver reliability kappa values of 0.43 and 0.37, respectively and interobserver reliability values of 0.18 and 0.25, respectively. The intraobserver reliability of a subjective opinion of yes/no response was 0.74 while the interobserver reliability was 0.21.

Conclusions

When evaluating a spectrum of hip dysplasia, commonly used measures of hip congruency have low intraobserver and interobserver relclassifications of Yasunaga et al. and Okano et al. Interobserver reliability for all three methods was low. New radiographic parameters to consistently identify congruency will be helpful for evaluating the preoperative indications for reconstructive osteotomy.

Clinical Relevance

Hip congruency has long been cited as a requirement for a reconstructive pelvic osteotomy, but based on the above findings, there is no clear agreement regarding what comprises a congruent joint. Thus, better criteria are needed to assess preoperative hip congruency to determine the role of congruency in patient outcomes after surgery for hip dysplasia.
Keywords: Medicine & Public Health, Conservative Orthopedics, Orthopedics, Sports Medicine, Surgery, Surgical Orthopedics, Medicine/Public Health, general

Resumen
Antecedentes

Una cadera congruente con frecuencia se cita en la bibliografía como un requisito previo para la realización de una osteotomía pélvica reconstructiva para la displasia de cadera.La designación como congruentes es importante como articulaciones incongruentes son generalmente considerados como que requiere un procedimiento de tipo de salvamento.Varias medidas de congruencia se describen en la literatura, pero no está claro si estas medidas son fiables.

Preguntas / fines

Por lo tanto, evaluamos los intraobservador e interobservador fiabilidad de tres medidas de congruencia de cadera en pacientes con displasia leve a severa.

métodos

Seleccionamos las radiografías de 30 pacientes con esqueleto maduro con displasia de cadera sintomática que eran candidatos potenciales para una osteotomía periacetabular.Todas las radiografías fueron calificados por seis los colaboradores en dos ocasiones.Los revisores se muestran una serie de vistas de AP y de von Rosen ya sea de la caderasintomática o el lado contralateral y les pidió que calificaran congruencia usando dosmedidas previamente publicados – las clasificaciones de Yasunaga et al. y Okano et al.Los revisores también se pidió para determinar si la cadera se basó congruente en suopinión subjetiva (sí / no). Las radiografías fueron revisados y mediciones se repitieron 1 mes después. Se realizó un análisis Kappa para determinar intraobservador y interraterconfiabilidad entre y dentro de los valores individuales, respectivamente.

resultados

El uso de las clasificaciones de Yasunaga et al. y Okano et al., encontramos valores kappa de fiabilidad intraobservador de 0.43 y 0.37, respectivamente, y los valores de fiabilidad interobservador de 0.18 y 0.25, respectivamente. La fiabilidad intraobservadorde una opinión subjetiva de sí / no respuesta fue de 0,74, mientras que la fiabilidadinterobservador fue de 0,21.

conclusiones

Al evaluar un espectro de la displasia de cadera, las medidas de uso común de la congruencia de cadera tienen bajos intraobservador e interobservador relclassificationsde Yasunaga et al. y Okano et al. Fiabilidad interobservador para los tres métodos era baja. Nuevos parámetros radiográficos para identificar sistemáticamente congruenciaserán útiles para evaluar las indicaciones preoperatorias para osteotomía reconstructiva.

Importancia clínica

Congruencia Hip mucho tiempo se ha citado como un requisito para una osteotomíapélvica reconstructiva, pero sobre la base de las conclusiones anteriores, no existe un acuerdo claro con respecto a lo que comprende una articulación congruente. Por lo tanto,son necesarios mejores criterios para evaluar la congruencia cadera preoperatoria para determinar el papel de la congruencia en los resultados del paciente después de la cirugía para la displasia de cadera.

Palabras clave: Medicina y Salud Pública, conservador Ortopedia, Traumatología,Medicina del Deporte, Cirugía, Ortopedia quirúrgica, Medicina / Salud Pública, el general