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1.
Susan W. Muir Aziz Al-Ahaideb John Huckell Mary Ann Johnson D. Bill C. Johnston Lauren A. Beaupre 《Canadian journal of surgery》2011,54(3):185-188
Background
Radiographic evaluation has a prominent place in the follow-up of long-term results of uncemented total hip arthroplasty (THA). The most prominent scale reported in studies is the Engh Grading Scale, but there is a lack of literature on the reliability of the scale.Methods
We evaluated intra- and interrater reliability of the Engh Grading System for uncemented THA using 26 follow-up radiographs of patients who had primary uncemented THAs. Four evaluators with different skill levels and specialties participated: 2 arthroplasty surgeons, an orthopedic resident and a radiologist. Reliability was measured using a weighted κ coefficient for paired comparisons among the evaluators.Results
Intrarater reliability was dependent on the skill and specialty of the evaluator, with the highest values achieved for the arthroplasty surgeons (κ = 0.52 and κ = 0.68) and the lowest values for the radiologist (κ = 0.14). Interrater reliability was comparable among participants, regardless of skill or specialty, and rated a moderate level of reliability (κ = 0.29–0.41) for all pairings.Conclusion
The Engh Grading Scale appears to be reliable when used by a single, experienced arthroplasty surgeon. Caution must be exercised when multiple raters are used, regardless of experience, as the interrater reliability achieved lower ratings. 相似文献2.
Michael C. Fu Rafael A. Buerba William D. Long III Daniel J. Blizzard Andrew W. Lischuk Andrew H. Haims Jonathan N. Grauer 《The spine journal》2014,14(10):2442-2448
Background context
Magnetic resonance imaging (MRI) is frequently used in the evaluation of degenerative conditions in the lumbar spine. The relative interrater and intrarater agreements of MRI findings across different pathologic conditions are underexplored, as most studies are focused on specific findings.Purpose
The purpose of this study was to characterize the interrater and intrarater agreements of MRI findings used to assess the degenerative lumbar spine.Study design
A retrospective diagnostic study at a large academic medical center was undertaken with a panel of orthopedic surgeons and musculoskeletal radiologists to assess lumbar MRIs using standardized criteria.Patient sample
Seventy-five subjects who underwent routine lumbar spine MRI at our institution were included.Outcome measures
Each MRI study was assessed for 10 lumbar degenerative findings using standardized criteria. Lumbar vertebral levels were assessed independently, where applicable, for a total of 52 data points collected per study.Methods
T2-weighted axial and sagittal MRI sequences were presented in random order to the four reviewers (two orthopedic spine surgeons and two musculoskeletal radiologists) independently to determine interrater agreement. The first 10 studies were reevaluated at the end to determine intrarater agreement. Images were assessed using standardized and pilot-tested criteria to assess disc degeneration, stenosis, and other degenerative changes. Interrater and intrarater absolute percent agreements were calculated. To highlight the most clinically important MRI disagreements, a modified agreement analysis was also performed (in which disagreements between the lowest two severity grades for applicable conditions were ignored). Fleiss kappa coefficients for interrater agreement were determined.Results
The overall absolute and modified interrater agreements were 76.9% and 93.5%, respectively. The absolute and modified intrarater agreements were 81.3% and 92.7%, respectively. Average Fleiss kappa coefficient was 0.431, suggesting moderate overall agreement. However, when stratified by condition, absolute interrater agreement ranged from 65.1% to 92.0%. Disc hydration, disc space height, and bone marrow changes exhibited the lowest absolute interrater agreements. The absolute intrarater agreement had a narrower range, from 74.5% to 91.5%. Fleiss kappa coefficients ranged from fair-to-substantial agreement (0.282–0.618).Conclusions
Even in a study using standardized evaluation criteria, there was significant variability in the interrater and intrarater agreements of MRI in assessing different degenerative conditions of the lumbar spine. Clinicians should be aware of the condition-specific diagnostic limitations of MRI interpretation. 相似文献3.
James J. McCarthy MD Christopher A. Iobst MD S. Robert Rozbruch MD Sanjeev Sabharwal MD Emily A. Eismann MS 《Clinical orthopaedics and related research》2013,471(2):621-627
Background
Although several systems exist for classifying specific limb deformities, there currently are no validated rating scales for evaluating the complexity of general lower limb deformities. Accurate assessment of the complexity of a limb deformity is essential for successful treatment. A committee of the Limb Lengthening and Reconstruction Society (LLRS) therefore developed the LLRS AIM Index to quantify the severity of a broad range of lower extremity deformities in seven domains.Questions/Purposes
We addressed two questions: (1) Does the LLRS AIM Index show construct validity by correlating with rankings of case complexity? (2) Does the LLRS AIM Index show sufficient interrater and intrarater reliabilities?Methods
We had eight surgeons evaluate 10 fictionalized patients with various lower limb deformities. First, they ranked the cases from simplest to most complex, and then they rated the cases using the LLRS AIM Index. Two or more weeks later, they rated the cases again. We assessed reliability using the Kendall’s W test.Results
Raters were consistent in their rankings of case complexity (W = 0.33). Patient rankings also correlated with both sets of LLRS AIM ratings (r2 = 0.25; r2 = 0.23). The LLRS AIM Index showed interrater reliability with an intraclass correlation (ICC) of 0.97 for Trial 1 and 0.98 for Trial 2 and intrarater reliability with an ICC of 0.94. The LLRS AIM Index ratings also were highly consistent between the attending surgeons and surgeons-in-training (ICC = 0.91).Conclusions
Our preliminarily observations suggest that the LLRS AIM Index reliably classifies the complexity of lower limb deformities in and between observers.Electronic supplementary material
The online version of this article (doi:10.1007/s11999-012-2609-8) contains supplementary material, which is available to authorized users. 相似文献4.
Stephen Croft Andrew Furey Craig Stone Carl Moores Robert Wilson 《Canadian journal of surgery》2015,58(1):58-62
Background
Radiographic measurements to document ankle anatomy have been suggested in recent literature to be inadequate. Focus has been put on stress views and computed tomography; however, there are also issues with these modalities. An orthogonal view that could be used both statically and dynamically could help determine syndesmotic stability. The purpose of this study was to determine a parameter on a normal lateral ankle radiograph that will increase the reliability of standard radiography in diagnosing syndesmotic integrity.Methods
Three orthopedic surgeons reviewed 80 lateral ankle radiographs. Thirty of those radiographs were reviewed on a second occasion. Rotation of the radiographs was determined by evaluating the overlap of the talar dome. Four radiographic parameters were measured 1 cm above the tibial plafond: fibular width, tibial width, and anterior and posterior tibiofibular intervals.Results
Seventy-two radiographs were determined by consensus to be adequate. Means and ratios were documented to determine the relationship of the fibula to the tibia. Interrater reliability ranged from moderate to near-perfect, and the intrarater reliability was documented for each ratio. The anterior tibiofibular ratio was shown to be strong to near-perfect. It demonstrates that 40% of the tibia should be seen anterior to the fibula at 1cm above the tibial plafond.Conclusion
The anterior tibiofibular ratio provides an orthogonal measure for the syndesmosis that, in conjunction with those parameters previously documented, could clinically and economically improve the diagnosis of syndesmotic disruptions. 相似文献5.
Purpose
The aim of this multicentre study was to determine whether the recently introduced AOSpine Classification and Injury Severity System has better interrater and intrarater reliability than the already existing Thoracolumbar Injury Classification and Severity Score (TLICS) for thoracolumbar spine injuries.Methods
Clinical and radiological data of 50 consecutive patients admitted at a single centre with a diagnosis of an acute traumatic thoracolumbar spine injury were distributed to eleven attending spine surgeons from six different institutions in the form of PowerPoint presentation, who classified them according to both classifications. After time span of 6 weeks, cases were randomly rearranged and sent again to same surgeons for re-classification. Interobserver and intraobserver reliability for each component of TLICS and new AOSpine classification were evaluated using Fleiss Kappa coefficient (k value) and Spearman rank order correlation.Results
Moderate interrater and intrarater reliability was seen for grading fracture type and integrity of posterior ligamentous complex (Fracture type: k = 0.43 ± 0.01 and 0.59 ± 0.16, respectively, PLC: k = 0.47 ± 0.01 and 0.55 ± 0.15, respectively), and fair to moderate reliability (k = 0.29 ± 0.01 interobserver and 0.44+/0.10 intraobserver, respectively) for total score according to TLICS. Moderate interrater (k = 0.59 ± 0.01) and substantial intrarater reliability (k = 0.68 ± 0.13) was seen for grading fracture type regardless of subtype according to AOSpine classification. Near perfect interrater and intrarater agreement was seen concerning neurological status for both the classification systems.Conclusions
Recently proposed AOSpine classification has better reliability for identifying fracture morphology than the existing TLICS. Additional studies are clearly necessary concerning the application of these classification systems across multiple physicians at different level of training and trauma centers to evaluate not only their reliability and reproducibility, but also the other attributes, especially the clinical significance of a good classification system.6.
Corey McGee 《Journal of hand therapy》2018,31(4):530-537
Study Design
Clinical measurement study.Introduction
Measuring the isometric strength generated during isolated hand joint motions is a challenging feat. The Rotterdam Intrinsic Hand Myometer (RIHM; med.engineers, Rotterdam, Netherlands) permits measurement of isolated movements of the hand. To date, there is limited evidence on the inter-rater reliability and limited adult normative data of RIHM. Given that multiple raters, often with varying degrees of experience, are needed to collect normative data, inter-rater reliability testing and a comparison of novice and experienced raters are needed.Purposes of the Study
The purposes of this study were to test the accuracy, intrarater reliability, and inter-rater reliability of the RIHM in healthy-handed adults.Methods
RIHM accuracy was tested through use of precision class F weights. Adults 18 years or older without upper limb dysfunction were recruited. Each participant was tested by 4 raters, 3 occupational therapy graduate students, and an experienced certified hand therapist, through use of a calibrated RIHM. Five strength measures were tested bilaterally (ie, thumb carpometacarpal palmar abduction, index finger metacarpophalangeal [MP] abduction, index finger MP flexion, thumb MP flexion, and small finger MP abduction) 3 times per a standardized protocol. Statistical methods were used to test accuracy, inter-rater reliability, and intrarater/response stability.Results
The accuracy of RIHM device error was 5% or less. Reliability testing included the participation of 19 women and 10 men (n = 29). All raters were in excellent agreement across all muscles (intraclass correlation coefficient, ≥0.81). Low standard error of measurement values of ≤8.3 N (1.9 lb) across raters were found. The response stability and/or intrarater reliability of the novice and certified hand therapist raters were not statistically different.Discussion
The RIHM has an acceptable instrument error; the RIHM and its standardized procedure have excellent inter-rater reliability and response stability when testing those without hand limitations; and the response stability and/or intrarater reliability of expert and novice raters were consistent.Conclusions
The use of the RIHM is justified when multiple raters of varying expertise collect normative data or conduct cohort studies on persons with healthy hands. Future research is warranted.Level of Evidence
Not applicable. 相似文献7.
Dahang Zhao Weiwei Rao Li Zhao Jianlin Liu Yaqing Chen Pinquan Shen Qing Du Luan Li 《International orthopaedics》2013,37(12):2415-2420
Purpose
There is some disagreement about whether idiopathic congenital talipes equinovarus (CTEV) increases the risk of neonatal developmental dysplasia of the hip (DDH). This study aimed to investigate the incidence of DDH in our infants with idiopathic CTEV.Methods
We conducted an observational cohort study over a three-year period to assess the relationship between idiopathic CTEV and DDH. All neonates younger than six weeks with idiopathic CTEV who were treated in our medical centre were admitted to this study. Each subject underwent hip ultrasound examination using the Graf method at the age of six weeks. DDH was diagnosed when a hip was type IIa(−) or worse according to the Graf classification of sonographic hip type.Results
A total of 184 patients were diagnosed with idiopathic CTEV and underwent hip sonography. In total, seven hips of five individuals underwent treatment (four girls and one boy). The results indicated that 2.7 % of babies (five of 184) with idiopathic CTEV had DDH. However, we did not find any statistically significant difference (p = 0.5776) in the Pirani scores between the DDH group and group with normal hips.Conclusions
This study revealed that the idiopathic CTEV group had a greater incidence of DDH in comparison with the general population. It is recommended that hip sonography be undertaken particularly in patients with idiopathic CTEV. 相似文献8.
Mihara K Shindo H Mihara H Ohtani M Nagasaki K Katoh N 《Burns : journal of the International Society for Burn Injuries》2012,38(3):371-377
Purpose
Videomicroscopy is very useful for burn depth assessment in an early phase; however, there is no practical classification that includes complicated anatomic, pathologic, and morphologic findings of burn wounds.The aim of this study was to propose a novel classification to assess burn depth in its early phase easily and reliably by videomicroscopy.Methods
Forty-four patients with 56 intermediate-depth burn wounds were included. Burn depth was divided into each grade according to our proposed classification, which is composed of five categories based on dermal capillary integrity patterns. The intrarater and interrater reliabilities of the assessment by the second and third authors were evaluated by Cohen's unweighted κ-value.Results
The results of the measurements according to the proposed classification showed an accuracy of 92.9%, sensitivity of 81.8%, and specificity of 100.0%.The intrarater reliability of the second and third authors showed substantial agreement (κ = 0.719 and 0.729, respectively). The interrater reliability of the sum of each observer's variable also showed substantial agreement (κ = 0.636).Conclusion
This pattern analysis system is easy to use even for inexperienced personnel, and is reliable with high accuracy and specificity. Intrarater and interrater statistics also support its reliability and reproducibility. 相似文献9.
Mohit Bhandari Scott M. Wasserman Nicole Yurgin Brad Petrisor Sheila Sprague Ricardo E. Dent 《Canadian journal of surgery》2013,56(5):E114-E120
Background
Assessing fracture healing in clinical trials is subjective. The new Function IndeX for Trauma (FIX-IT) score provides a simple, standardized approach to assess weight-bearing and pain in patients with lower extremity fractures. We conducted an initial validation of the FIX-IT score.Methods
We conducted a cross-sectional study involving 50 patients with lower extremity fractures across different stages of healing to evaluate the reliability and preliminary validity of the FIX-IT score. Patients were independently examined by 2 orthopedic surgeons, 1 orthopedic fellow, 2 orthopedic residents and 2 research coordinators. Patients also completed the Short Form-36 version 2 (SF-36v2) questionnaire, and convergent validity was tested with the SF-36v2.Results
For interrater reliability, the intraclass correlation coefficents ranged from 0.637 to 0.915. The overall interrater reliability for the total FIX-IT score was 0.879 (95% confidence interval 0.828–0.921). The correlations between the FIX-IT score and the SF-36 ranged from 0.682 to 0.770 for the physical component summary score, from 0.681 to 0.758 for the physical function subscale, and from 0.677 to 0.786 for the role–physical subscale.Conclusion
The FIX-IT score had high interrater agreement across multiple examiners. Moreover, FIX-IT scores correlate with the physical scores of the SF-36. Although additional research is needed to fully validate FIX-IT, our results suggest the potential for FIX-IT to be a reliable adjunctive clinician measure to evaluate healing in lower extremity fractures.Level of evidence
Diagnostic Study Level I. 相似文献10.
Sabit Sllamniku Cen Bytyqi Ardiana Murtezani Emir Q. Haxhija 《Journal of children's orthopaedics》2013,7(6):501-505
Purpose
This study assessed whether avascular necrosis (AVN) is correlated with the presence or absence of the ossific nucleus (ON) at the initiation of conservative treatment for developmental dysplasia of the hip (DDH). To date, the correlation between the presence of the ON and AVN manifestations remains ambiguous.Methods
The medical records of 148 patients with 234 dislocated hips who presented at our institution between January 2006 and December 2007 were reviewed. Based on ultrasound examination, the hips were classified according to Graf IIIa, IIIb, and IV criteria. Patients aged >6 months were simultaneously examined by standardized pelvis radiography.Results
The ON was present in 84 hips (35.9 %) at the beginning of treatment. Treatment was begun at a mean age of 5 months, with overhead traction for 2 weeks followed by arthrography and a spica cast for 4 weeks. Afterwards, we used a Tübingen hip-flexion splint. The mean age at final follow-up was 87 months. Hips were radiographically evaluated at last follow-up according to the Ogden–Bucholz AVN classification scheme. There was no significant difference in AVN prevalence between ON− versus ON+ hips in children aged ≤10 months (P = 0.681), whereas when all age groups were analyzed together, AVN was significantly increased in ON+ hips (P = 0.002). Clinical examination revealed no differences in limping, leg length inequality, and range of motion of hips in the ON− versus ON+ groups.Conclusion
We conclude that DDH treatment should be performed early without regard to the presence or absence of the ON. Reduction should not be delayed beyond >10 months of age because any delay in treatment increases the incidence of AVN. 相似文献11.
Background and objective
Acetabular cup orientation, consisting of pelvic positioning, version and inclination, can influence short-term and long-term results after total hip arthroplasty (THA). The radiographic measurement of acetabular cup inclination represents an indicator of quality for the EndoCert certification in Germany. The purpose of this study was to determine the intrarater and interrater reliability of radiographic measurements of acetabular cup inclination after THA.Material and methods
In this study four independent investigators with different levels of expertise retrospectively performed measurements on radiograms (anteroposterior pelvic radiogram) from 99 patients. The intraclass correlation coefficient (ICC) and Pearson’s correlation coefficient were determined and were considered statistically significant with r?>?0.8 and p?<?0.05.Results and conclusion
A high correlation was found for both intrarater and interrater reliability based on determination of Pearson’s correlation coefficient and the ICC with r?>?0.9 and p?<?0.001 for all measurements. Based on these results the radiographic measurement of acetabular cup inclination can be considered as a simple measuring tool with high intrarater and interrater reliability. As cup orientation consists of inclination, version and positioning, the exclusive measurement of cup inclination for radiological quality assessment needs to be discussed critically.12.
Naaz Kapadia MSc Vera Zivanovic MD Molly Verrier MHSc Milos R. Popovic PhD 《Topics in spinal cord injury rehabilitation》2012,18(2):167-186
Purpose:
The objective of this study was to evaluate the interrater reliability, construct validity, and sensitivity of Toronto Rehabilitation Institute–Hand Function Test (TRI-HFT), within an interventional randomized control trial.Method:
Twenty-one participants with subacute C4 to C7 spinal cord injury (SCI) were recruited. Based on randomization, participants were allocated to either the functional electrical stimulation therapy group or the conventional occupational therapy group. Baseline and follow-up assessments of participants were videotaped. For testing interrater reliability, videotaped images were transferred to DVDs that were later observed by 2 observers. Construct validity was determined by comparing total scores on TRI-HFT to self-care subscore components of the Spinal Cord Independence Measure (SCIM) and FIM. To establish sensitivity of TRI-HFT, we compared pre- and posttreatment scores on all 3 measures (ie, TRI-HFT, FIM, and SCIM).Results:
TRI-HFT was found to have high interrater reliability with an intercorrelation coefficient (ICC) of 0.98. Moderate to strong correlations were found between TRI-HFT total scores and self-care components of FIM and SCIM for both hands individually post therapy. Due to a floor effect of the FIM and SCIM, there was weak correlation between pretherapy scores of the said measures and TRI-HFT. TRI-HFT was found to be highly sensitive in determining difference in function pre and post therapy.Conclusions:
This study demonstrated that the TRI-HFT is a reliable and sensitive measure to assess unilateral hand gross motor function in persons with tetraplegia, with moderate to strong construct validity. 相似文献13.
Background
Orthopedic surgical education in Canada has seen major change in the last 15 years. Work hour restrictions and external influence have led to new approaches for surgical training. With a change toward competency-based educational models under the CanMEDS headings there is a need to ensure the validity of modern assessment methods. Our objective was to evaluate the reliability of a currently used surgical skill assessment tool within an orthopedic residency program, as measured by the Surgical Encounters Form.Methods
A surgical assessment tool has previously been created at our institution that comprises 15 items spanning 4 of the CanMEDS competencies. Results were blinded to the primary investigator and coded by a third party. The assessments were collected, and we measured percent agreement using Cronbach’s α and Fleiss κ.Results
Over a 5-month period 11 staff members assessed 10 residents. Eighty-eight assessments were completed in total. Weighted percent agreement was 90.9%. Cronbach’s α averaged 0.865 for the medical expert role, 0.920 for technical skills, 0.934 for the communicator role, 1.00 for the collaborator role and 1.00 for the health advocate role. The mean Fleiss κ score was 0.147 (95% confidence interval &0.071 to 0.364), demonstrating low interrater reliability.Conclusion
Despite the development of a validated assessment tool to evaluate surgical skills acquisition, interrater reliability results suggest low levels of agreement among assessors. 相似文献14.
Mohamed El-Sayed Tarek Ahmed Sameh Fathy Hosam Zyton 《Journal of children's orthopaedics》2012,6(6):471-477
Introduction
The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to evaluate the short- to middle-term clinical and radiographic results of the management of DDH.Patients and methods
Patients less than 6 years old using two of the most commonly used osteotomies, namely, Salter innominate osteotomy and the Dega acetabuloplasty. Special attention was paid to acetabular remodeling after concentric reduction, which was monitored by the acetabular index, that, in turn, was measured preoperatively, immediately postoperatively, every 6 months, and at the final follow-up examination.Results
The final overall clinical end results were favorable (excellent or good) in 93 hips (85.3 %). There was a marked improvement of the acetabular coverage during the follow-up period, which proved the good remodeling potential of the acetabulum for this particular age group after concentric reduction was achieved and maintained.Conclusion
Both osteotomy types were found to be adequate for the management of neglected walking DDH patients under the age of 6 years. 相似文献15.
16.
Purpose
Total hip arthroplasty (THA) is an effective procedure for developmental dysplasia of the hip (DDH); however, it is sometimes difficult to complete for severe cases because of femoral head dislocation, dysplasia of the acetabulum and the femur, disparity in limb length, soft tissue contraction, and muscular atrophy. We aimed at exploring the efficiency of the techniques of release and balance of soft tissues and reconstruction of true socket THA for patients with severe DDH.Methods
From January 2000 to January 2009, 46 adult patients with severe DDH (50 hips) were included in this study. According to the classification system, there were 26 type III and 24 type IV. Among them there were 32 women and 14 men, aged from 38 to 77 years. THA was performed via a lateral approach. All acetabular sockets were reconstructed at the original anatomical location following a meticulous technique of soft tissue release and balance around the hip to restore limb length, to strengthen the abductor and improve its function.Results
All patients had restoration of limb length (range, 2.5–5.5 cm; 30 limbs of more than 4 cm) without injury to the sciatic nerve. One postoperative dislocation occurred due to slight enlargement of the angle of abduction of the acetabulum. The follow-up ranged from 2.2 to 11.5 years (median 6.4 years) in 46 patients, and the Harris score increased from 40.2 preoperatively to 86.5 (P = 0.027). All hips were pain free with good function at the latest follow-up.Conclusion
The meticulous techniques of soft tissue release and balance can be recommended to ensure anatomical reconstruction of the true acetabular socket and to improve abductor function during arthroplasty for DDH. 相似文献17.
Lene Spanager Randi Beier-Holgersen Peter Dieckmann Lars Konge Jacob Rosenberg Doris Oestergaard 《American journal of surgery》2013
Background
Nontechnical skills are essential for safe and efficient surgery. The aim of this study was to evaluate the reliability of an assessment tool for surgeons' nontechnical skills, Non-Technical Skills for Surgeons dk (NOTSSdk), and the effect of rater training.Methods
A 1-day course was conducted for 15 general surgeons in which they rated surgeons' nontechnical skills in 9 video recordings of scenarios simulating real intraoperative situations. Data were gathered from 2 sessions separated by a 4-hour training session.Results
Interrater reliability was high for both pretraining ratings (Cronbach's α = .97) and posttraining ratings (Cronbach's α = .98). There was no statistically significant development in assessment skills. The D study showed that 2 untrained raters or 1 trained rater was needed to obtain generalizability coefficients >.80.Conclusions
The high pretraining interrater reliability indicates that videos were easy to rate and Non-Technical Skills for Surgeons dk easy to use. This implies that Non-Technical Skills for Surgeons dk (NOTSSdk) could be an important tool in surgical training, potentially improving safety and quality for surgical patients. 相似文献18.
Background and purpose
Different methods have been used to classify osteoarthritis (OA) of the hip. We evaluated the reliability of different classifications in order to find which grading system is most appropriate for use in clinical practice.Patients and methods
49 patients (61 affected hips) with late-detected developmental dislocation of the hip (DDH) were studied. The mean age at follow-up was 45 (32–49) years. 3 classifications of OA were compared. The gradings by Kellgren and Lawrence (1957) (K&L) and Croft et al. (1990) are global visual assessments based on osteophytes, cysts, subchondral sclerosis, and narrowing of the joint space. The third classification is based on narrowing in the upper, weight-bearing part of the joint and defines as OA a minimum joint space width (JSW) of less than 2.0 mm at the narrowest part. 2 experienced observers, one radiologist and one orthopedic surgeon, assessed and measured the radiographs.Results
Minimum JSW (< 2.0 mm in 9 hips) gave the best inter-observer agreement (kappa value = 0.87). Using the K&L grading, inter-observer agreement was moderate (kappa = 0.55), but kappa increased when the number of categories was reduced from 5 to 3 (no OA, mild OA, and severe OA). The Croft classification gave similar agreement as the K&L grading. The intra-observer agreement was better than inter-observer agreement, irrespective of the grading system. There was a good accordance between the minimum JSW and the 2 other methods.Interpretation
Joint space narrowing using a minimum JSW of < 2.0 mm as criterion for OA was the simplest and most reproducible classification in long-term follow-up of patients with DDH. A classification based on global visual assessment can be used in addition if only hips with severe OA are included.Osteoarthritis (OA) of the hip is the endpoint in follow-up studies of developmental dislocation of the hip (DDH) when comparing the outcome of different treatment regimes (Malvitz and Weinstein 1994, Angliss et al. 2005, Thomas et al. 2007). Different classifications of OA have been used, and our knowledge about the relationship between them is limited. Thus, comparison between long-term studies is difficult. A simple and reproducible grading system for use in future studies would be desirable.OA of the hip can be evaluated by overall global assessment (Kellgren and Lawrence 1957, Croft et al. 1990, Tönnis and Heinecke 1999) or by measurement of the joint space width (JSW) (Croft et al. 1990, Jacobsen and Sonne-Holm 2005). Although measurement of JSW has been found to be more reproducible than gradings based on visual assessment in epidemiological studies and in certain patient groups (Croft et al. 1990, Troelsen et al. 2010), no such comparison has been performed in patients with DDH.The aims of the present study were to answer the following questions: 1. How reproducible are different radiographic classifications of OA in long-term follow-up of patients with DDH?2. Which classification is most suitable for use in clinical practice and research? 相似文献19.
Purpose
At present, the indications for femoral derotational osteotomy remain controversial due to the inconsistent findings in femoral neck anteversion in developmental dysplasia of the hip (DDH). Moreover, combined anteversion is not assessed in unilateral DDH using three dimensional-CT. Therefore, the purposes of our study were to observe whether the femoral neck anteversion (FA), acetabular anteversion (AA) and combined anteversion (CA) on the dislocated hips were universally presented in unilateral DDH according to the classification system of Tönnis.Methods
Sixty-two patients with unilateral dislocation of hip were involved in the study, including 54 females and eight males with a mean age of 21.63 months (range, 18–48 months). The FA, AA and CA were measured and compared between the dislocated hips and the unaffected hips.Results
Although no significant difference was observed in FA between the dislocated hips and the unaffected hips (P = 0.067, 0.132, respectively) in Tönnis II and III type, FA was obviously increased on the dislocated hips compared with the unaffected hips in Tönnis IV type. Increased AA on the dislocated hips was a universal finding in Tönnis II, III and IV types. Meanwhile, a wide safe range of CA from 24° to 62° was demonstrated on the unaffected hips.Conclusion
Femoral derotational osteotomy seems not to be necessary in Tönnis II and III types in unilateral DDH. Femoral derotational osteotomy should be considered in DDH, especially in Tönnis IV type, if the CA is still above 62° and the hip joints present instability in operation after abnormal acetabular anteversion, acetabular index and acetabular coverage of the femoral head are recovered to normal range through pelvic osteotomy. 相似文献20.
Pil Whan Yoon Jung Il Kim Dong Ok Kim Cheol Hwan Yu Jeong Joon Yoo Hee Joong Kim Kang Sup Yoon 《Clinics in Orthopedic Surgery》2013,5(3):167-173