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Reliability and Agreement of Measures Used in Radiographic Evaluation of the Adult Hip

Abstract

Background

Several mechanical derangements reportedly contribute to the development of noninflammatory arthritis of the hip. Diagnosis of these derangements involves the use of specific radiographic measures (eg, alpha angle, lateral center edge angle, cross-over sign). The reliability of some of these measures is not known, whereas others have not been confirmed.

Questions/purposes

We examined the reproducibility of 20 radiographic parameters of the hip used in clinical practice.

Methods

Twenty radiographic parameters on standardized digital AP and cross-table lateral radiographs were evaluated by two observers on two different occasions. The parameters were evaluated from the standpoint of reproducibility (reliability and agreement). The intraclass correlation coefficient (ICC), kappa coefficient, and standard error of measurement were calculated. The minimal detectable change was calculated where possible.

Results

Interrater reliability ranged from 0.45 to 0.90 for ICC depending on the measure. Intrarater reliability ranged from 0.55 to 0.99. Measurements that could be measured directly (femoral head diameter) were more reliable than measurements requiring estimation on the part of the observer (Tönnis angle, neck-shaft angle). Categorical parameters had interrater and intrarater reliability kappa values greater than 0.90 for all parameters measured. Agreement between repeated measurements, as given by the minimal detectable change, showed many parameters with low absolute reliability have clinical use in the context of the large changes seen in clinical practice.

Conclusion

Radiographic hip measures show clinical utility when evaluated from the perspective of agreement and reliability.

Clinical Relevance

All measures investigated show clinical utility when evaluated from the perspective of reliability and agreement.

Level of Evidence

Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Fig. 1A–B

References

  1. 1.

    Anderson LA, Peters CL, Park BB, Stoddard GJ, Erickson JA, Crim JR. Acetabular cartilage delamination in femoroacetabular impingement: risk factors and magnetic resonance imaging diagnosis. J Bone Joint Surg Am. 2009;91:305–313.

  2. 2.

    Atkinson G, Nevill AM. Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine. Sports Med 1998;26:217–238.

  3. 3.

    Bartko JJ. The intraclass correlation coefficient as a measure of reliability. Psychol Rep. 1966;19:3–11.

  4. 4.

    Beaulé PE, Allen DJ, Clohisy JC, Schoenecker P, Leunig M. The young adult with hip impingement: deciding on the optimal intervention. J Bone Joint Surg Am. 2009;91:210–221.

  5. 5.

    Byrt T, Bishop J, Carlin JB. Bias, prevalence and kappa. J Clin Epidemiol. 1993;46:423–429.

  6. 6.

    Chmura Kraemer H, Periyakoil VS, Noda A. Kappa coefficients in medical research. Stat Med. 2002; 21:2109–2129.

  7. 7.

    Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ, Leunig M, Schoenecker PL, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(suppl 4):47–66.

  8. 8.

    Clohisy JC, Carlisle JC, Trousdale R, Kim YJ, Beaule PE, Morgan P, Steger-May K, Schoenecker PL, Millis M. Radiographic evaluation of the hip has limited reliability. Clin Orthop Relat Res. 2009;467:666–675.

  9. 9.

    de Vet HC, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59:1033–1039.

  10. 10.

    Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272.

  11. 11.

    Gosvig KK, Jacobsen S, Palm H, Sonne-Holm S, Magnusson E. A new radiological index for assessing asphericity of the femoral head in cam impingement. J Bone Joint Surg Br. 2007;89:1309–1316.

  12. 12.

    Gosvig KK, Jacobsen S, Sonne-Holm S, Gebuhr P. The prevalence of cam-type deformity of the hip joint: a survey of 4151 subjects of the Copenhagen Osteoarthritis Study. Acta Radiol 2008;49:436–441.

  13. 13.

    Hopkins WG. Measures of reliability in sports medicine and science. Sports Med. 2000;30:1–15.

  14. 14.

    Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res. 2007;25:758–765.

  15. 15.

    Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466:677–683.

  16. 16.

    Kay RM, Jaki KA, Skaggs DL. The effect of femoral rotation on the projected femoral neck-shaft angle. J Pediatr Orthop. 2000;20:736–739.

  17. 17.

    Kraemer HC. Extension of the kappa coefficient. Biometrics. 1980;36:207–216.

  18. 18.

    Landis JR, Koch GG. A one-way components of variance model for categorical data. Biometrics. 1977;33:671–679.

  19. 19.

    Leunig M, Beck M, Kalhor M, Kim YJ, Werlen S, Ganz R. Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology. 2005;236:237–246.

  20. 20.

    Mackinnon A. A spreadsheet for the calculation of comprehensive statistics for the assessment of diagnostic tests and inter-rater agreement. Comput Biol Med. 2000;30:127–134.

  21. 21.

    Mast JW, Brunner RL, Zebrack J. Recognizing acetabular version in the radiographic presentation of hip dysplasia. Clin Orthop Relat Res. 2004;418:48–53.

  22. 22.

    Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–185.

  23. 23.

    Mose K. Methods of measuring in Legg-Calve-Perthes disease with special regard to the prognosis. Clin Orthop Relat Res. 1980;150:103–109.

  24. 24.

    Murphy SB, Ganz R, Muller ME. The prognosis in untreated dysplasia of the hip: a study of radiographic factors that predict the outcome. J Bone Joint Surg Am. 1995;77:985–989.

  25. 25.

    Murphy SB, Kijewski PK, Millis MB, Harless A. Acetabular dysplasia in the adolescent and young adult. Clin Orthop Relat Res. 1990;261:214–223.

  26. 26.

    Nelitz M, Guenther KP, Gunkel S, Puhl W. Reliability of radiological measurements in the assessment of hip dysplasia in adults. Br J Radiol. 1999;72:331–334.

  27. 27.

    Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84:556–560.

  28. 28.

    Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–785.

  29. 29.

    Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.

  30. 30.

    Sharp IK. Acetabular dysplasia: the acetabular angle. J Bone Joint Surg Br. 1961;43:268–272.

  31. 31.

    Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–428.

  32. 32.

    Siebenrock KA, Leunig M, Ganz R. Periacetabular osteotomy: the Bernese experience. Instr Course Lect. 2001;50:239–245.

  33. 33.

    Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85:257–268.

  34. 34.

    Steppacher SD, Tannast M, Ganz R, Siebenrock KA. Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res. 2008;466:1633–1644.

  35. 35.

    Tan L, Aktas S, Copuroglu C, Ozcan M, Ture M. Reliability of radiological parameters measured on anteroposterior pelvis radiographs of patients with developmental dysplasia of the hip. Acta Orthop Belg. 2001;67:374–379.

  36. 36.

    Tannast M, Mistry S, Steppacher SD, Reichenbach S, Langlotz F, Siebenrock KA, Zheng G. Radiographic analysis of femoroacetabular impingement with Hip2Norm-reliable and validated. J Orthop Res. 2008;26:1199–1205.

  37. 37.

    Tannast M, Murphy SB, Langlotz F, Anderson SE, Siebenrock KA. Estimation of pelvic tilt on anteroposterior X-rays: a comparison of six parameters. Skeletal Radiol. 2006;35:149–155.

  38. 38.

    Tannast M, Siebenrock KA. Conventional radiographs to assess femoroacetabular impingement. Instr Course Lect. 2009;58:203–212.

  39. 39.

    Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis–what the radiologist should know. AJR Am J Roentgenol. 2007;188:1540–1552.

  40. 40.

    Tannast M, Zheng G, Anderegg C, Burckhardt K, Langlotz F, Ganz R, Siebenrock KA. Tilt and rotation correction of acetabular version on pelvic radiographs. Clin Orthop Relat Res. 2005;438:182–190.

  41. 41.

    Tönnis D. Congenital Dysplasia and Dislocation of the Hip in Children and Adults. New York, NY: Springer; 1987.

  42. 42.

    Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.

  43. 43.

    Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med. 1998;17:101–110.

  44. 44.

    Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint: With special reference to the complication of osteoarthritis. Acta Chir Scand Suppl 1939;83(suppl 58):1–135.

  45. 45.

    Wiig O, Terjesen T, Svenningsen S. Inter-observer reliability of radiographic classifications and measurements in the assessment of Perthes’ disease. Acta Orthop Scand. 2002;73:523–530.

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Acknowledgments

We thank the AO Foundation for their continued support of international collaboration and study. We also thank Anne Mannion PhD, for valuable insight in editing and preparation of the manuscript.

Author information

Correspondence to Nicholas H. Mast MD.

Additional information

One or more of the authors (NHM) received financial support from AO North America (Paoli, PA, USA).

Each author certifies all investigations related to this study were conducted in conformity with ethical principles of research.

This work was performed at Schulthess Klinik, Zurich, Switzerland.

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Mast, N.H., Impellizzeri, F., Keller, S. et al. Reliability and Agreement of Measures Used in Radiographic Evaluation of the Adult Hip. Clin Orthop Relat Res 469, 188–199 (2011). https://doi.org/10.1007/s11999-010-1447-9

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Keywords

  • Femoral Head
  • Intraclass Correlation Coefficient
  • Alpha Angle
  • Minimal Detectable Change
  • Intrarater Reliability