Clinical Orthopaedics and Related Research

, Volume 467, Issue 3, pp 666–675 | Cite as

Radiographic Evaluation of the Hip has Limited Reliability

  • John C. Clohisy
  • John C. Carlisle
  • Robert Trousdale
  • Young-Jo Kim
  • Paul E. Beaule
  • Patrick Morgan
  • Karen Steger-May
  • Perry L. Schoenecker
  • Michael Millis
Symposium: Femoroacetabular Impingement: Current Status of Diagnosis and Treatment


Radiographic evaluation provides essential information regarding the diagnosis and treatment of musculoskeletal disorders. We evaluated the ability of hip specialists to reliably identify important radiographic features and to make a diagnosis based on plain radiographs alone. Five hip specialists and one fellow performed a blinded radiographic review of 25 control hips, 25 hips with developmental dysplasia (DDH), and 27 with femoroacetabular impingement (FAI). On two separate occasions, readers assessed acetabular version, inclination and depth, position of the femoral head center, head sphericity, head-neck offset, Tönnis grade, and joint congruency. Observers made a diagnosis categorizing each hip as normal, dysplastic, FAI, or combined DDH and FAI (features of both). Reliability was determined using Cohen’s kappa coefficient. Intraobserver values were highest for acetabular inclination (κ = 0.72) and determination of femoral head center position (κ = 0.77). Interobserver reliability values were highest for acetabular inclination (κ = 0.61) and Tönnis osteoarthritis grade (κ = 0.59). All other measurements, including diagnosis, had kappa values less than 0.55. We concluded many of the standard radiographic parameters used to diagnose DDH and/or FAI are not reproducible. Accordingly, a more clear set of definitions and measurements must be developed to allow for more reliable diagnosis of early hip disease.

Level of Evidence: Level III, diagnostic study. See the guidelines for authors for a complete description of the levels of evidence.


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Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • John C. Clohisy
    • 1
  • John C. Carlisle
    • 1
  • Robert Trousdale
    • 2
  • Young-Jo Kim
    • 3
  • Paul E. Beaule
    • 4
  • Patrick Morgan
    • 5
  • Karen Steger-May
    • 6
  • Perry L. Schoenecker
    • 7
  • Michael Millis
    • 3
  1. 1.Department of Orthopaedic SurgeryWashington University School of MedicineSt LouisUSA
  2. 2.The Mayo ClinicRochesterUSA
  3. 3.Adolescent/Young Adult Hip Unit, Department of Orthopaedic SurgeryChildren’s Hospital BostonBostonUSA
  4. 4.Ottawa General HospitalOttawaCanada
  5. 5.Department of Orthopedic SurgeryUniversity of Minnesota Medical SchoolMinneapolisUSA
  6. 6.Division of BiostatisticsWashington University School of MedicineSt LouisUSA
  7. 7.Shriner’s Hospital for ChildrenSt LouisUSA

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