Good inter- and intraobserver reliability for assessment of the slip angle in 77 hip radiographs of children with a slipped capital femoral epiphysis

Background and purpose — The decision on and the outcome of treatment for a slipped capital femoral epiphysis (SCFE) depend on the severity of the slip. In 2015, web-based registration was introduced into the Swedish Pediatric Orthopedic Quality (SPOQ) register. To determine whether the inclusion of commonly used methods in Sweden for radiographic measurement of SCFE (the calcar femorale [CF] method and the Billing method) is justified, we measured the inter- and intraobserver reliability of these 2 measurements. We also evaluated the internationally more commonly used head-shaft angle (HSA) method.

Material and methods — 4 observers with different levels of experience with radiographic measurements analyzed 77 routine preoperative hip radiographs of children with SCFE. Inter- and intraobserver reliability was evaluated.

Results — The interobserver reliability analysis for the 4 observers showed for CF an ICC of 0.99 (CI 0.97–0.99) and for Billing an ICC of 0.99 (CI 0.98–0.99). The interobserver reliability analysis for 2 observers showed for HSA an ICC of 0.98 (CI 0.97–0.99).

Intraobserver reliability (2 observers) showed a mean difference below 1° for all 3 methods and with a 95% limit of agreement not exceeding ±6.8°.

Interpretation — We found good reliability for both intra- and interobserver measurements of all 3 methods used for the assessment of the slip angle on routine preoperative lateral hip radiographs.