Skeletal Radiology

, Volume 35, Issue 5, pp 282–287

Reliability of the Crowe und Hartofilakidis classifications used in the assessment of the adult dysplastic hip

  • Ralf Decking
  • Alexander Brunner
  • Jens Decking
  • Wolfhart Puhl
  • Klaus-Peter Günther
Scientific Article

Abstract

Objective

To assess the inter-observer and intra-observer reliability of two commonly used radiographic classification systems in the evaluation of hip dysplasia in skeletally mature adults.

Design

Three observers with different levels of training independently classified 62 dysplastic hips on 51 standard anteriorposterior pelvis radiographs according to the criteria defined by Crowe and by Hartofilakidis. To assess intra-observer reliability, the same radiographs were reviewed 3 months later by the same observers.

Patients

At the time of the radiographic examination, the mean age of the 51 patients had been 54 years (range 18–82 years).

Results

A high correlation concerning the inter- and intra-observer reliability of both systems was demonstrated. Inter-observer reliability displayed a weighted kappa coefficient of 0.82 for the Crowe and 0.75 for the Hartofilakidis classification. Intra-observer reliability showed a kappa coefficient of 0.86 and 0.79, respectively.

Conclusions

Both classification systems can be recommended to compare collectives of adult patients with congenital dysplasia of the hip. However, for future clinical practice, it would be advisable to agree on one universally accepted system as a standard in the literature.

Keywords

Hip Dysplasia Prosthesis Classification 

References

  1. 1.
    Cameron HU, Botsford DJ, Park YS (1996) Influence of the Crowe rating on the outcome of total hip arthroplasty in congenital hip dysplasia. J Arthroplasty 11(5):582–587CrossRefPubMedGoogle Scholar
  2. 2.
    Hartofilakidis G, Karachalios T (2004) Total hip arthroplasty for congenital hip disease. J Bone Joint Surg Am 86-A(2):242–250Google Scholar
  3. 3.
    Crowe JF, Mani VJ, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg [Am] 61(1):15–23Google Scholar
  4. 4.
    Eftekhar NS (1978) Principles of total hip arthroplasty. Mosby, St. LouisGoogle Scholar
  5. 5.
    Hartofilakidis G, Stamos K, Ioannidis TT (1988) Low friction arthroplasty for old untreated congenital dislocation of the hip. J Bone Joint Surg [Br] 70(2):182–186Google Scholar
  6. 6.
    Kerboull M, Mathieu M, Sauzieres P (1987) Total hip replacement for congenital dysplasia of the hip. In: Postel M, Kerboull M, Evrard J, Courpied JP (eds) Total hip replacement. Springer, Berlin Heidelberg New York, pp. 51–66Google Scholar
  7. 7.
    Mendes DG, Said MS, Aslan K (1996) Classification of adult congenital hip dysplasia for total hip arthroplasty. Orthopedics 19(10):881–887PubMedGoogle Scholar
  8. 8.
    Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N (1996) Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg Am 78(5):683–692PubMedGoogle Scholar
  9. 9.
    Cicchelli DV, Allison T (1971) A new procedure for assessing reliability of scoring EEG sleep recordings. Am J EEG Technol 11:101–109Google Scholar
  10. 10.
    Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, New YorkGoogle Scholar
  11. 11.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174PubMedCrossRefGoogle Scholar
  12. 12.
    Svanholm H, Starklint H, Gundersen HJ, Fabricius J, Barlebo H, Olsen S (1989) Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic. Apmis 97(8):689–698PubMedCrossRefGoogle Scholar
  13. 13.
    Rasmussen S, Madsen PV, Bennicke K (1993) Observer variation in the Lauge-Hansen classification of ankle fractures. Precision improved by instruction. Acta Orthop Scand 64(6):693–694PubMedCrossRefGoogle Scholar
  14. 14.
    Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoenberg N (1993) The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am 75(12):1745–1750PubMedGoogle Scholar
  15. 15.
    Sharp IK (1961) Acetabular dysplasia: the acetabular angle. J Bone Joint Surg Br 43 B(2):268–272Google Scholar
  16. 16.
    Nelitz M, Guenther KP, Gunkel S, Puhl W (1999) Reliability of radiological measurements in the assessment of hip dysplasia in adults. Br J Radiol 72(856):331–334PubMedGoogle Scholar
  17. 17.
    Ward WT, Vogt M, Grudziak JS, Tumer Y, Cook PC, Fitch RD (1997) Severin classification system for evaluation of the results of operative treatment of congenital dislocation of the hip. A study of intraobserver and interobserver reliability. J Bone Joint Surg Am 79(5):656–663PubMedGoogle Scholar
  18. 18.
    Smith SW, Meyer RA, Connor PM, Smith SE, Hanley EN, Jr (1996) Interobserver reliability and intraobserver reproducibility of the modified Ficat classification system of osteonecrosis of the femoral head. J Bone Joint Surg Am 78(11):1702–1706PubMedGoogle Scholar
  19. 19.
    Thomsen NO, Overgaard S, Olsen LH, Hansen H, Nielsen ST (1991) Observer variation in the radiographic classification of ankle fractures. J Bone Joint Surg Br 73(4):676–678PubMedGoogle Scholar
  20. 20.
    Bobak P, Wroblewski BM, Siney PD, Fleming PA, Hall R (2000) Charnley low-friction arthroplasty with an autograft of the femoral head for developmental dysplasia of the hip. The 10- to 15-year results. J Bone Joint Surg Br 82(4):508–511CrossRefPubMedGoogle Scholar
  21. 21.
    Haddad FS, Masri BA, Garbuz DS, Duncan CP (1999) Primary total hip replacement of the dysplastic hip. J Bone Joint Surg Am 81-A(10):1462–1482Google Scholar

Copyright information

© ISS 2006

Authors and Affiliations

  • Ralf Decking
    • 1
  • Alexander Brunner
    • 1
  • Jens Decking
    • 2
  • Wolfhart Puhl
    • 1
  • Klaus-Peter Günther
    • 1
    • 3
  1. 1.Orthopaedic Department, RKUUniversity of UlmUlmGermany
  2. 2.Department of Orthopaedic SurgeryJohannes Gutenberg University School of MedicineMainzGermany
  3. 3.Department of OrthopaedicsUniversity-Hospital Carl Gustav CarusDresdenGermany

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