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Post-operative radiograph assessment of children undergoing closed reduction and spica cast immobilization for developmental dysplasia of the hip: does experience matter?

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Abstract

Purpose

Closed reduction and spica cast immobilization are routinely used for young patients with developmental dysplasia of the hip with reducible hips. Our primary objective was to assess the interpretation quality of immediate post-operative pelvis radiographs after treatment.

Methods

A series of 28 randomly selected patients (30 hips) with pre- and post-operative pelvis radiographs and post-operative magnetic resonance imaging were included. Each was presented twice with an interval of two weeks, in alternating orders. Raters with different experience and specialties from different institutions rated the quality of reduction (hip in or out) after treatment.

Results

Thirteen surgeons and three radiologists evaluated 30 hips (28 patients). Agreement was not satisfactory (κ = 0.12). Experienced clinicians demonstrated similar agreement to inexperienced raters (κ = 0.04). Consistency at a two week interval was moderate (κ = 0.48, percent of agreement at 82%). The mean number of errors from the two ratings were 8.6 ± 2.5 and 8.9 ± 2.7, respectively (P = 0.72). There was no significant difference between surgeons with different levels of experience; radiologists did better than surgeons, but the difference was insignificant. Raters from different institutions had similar performance in poor judgment.

Conclusions

Our results show poor concordance between observers and ratings. Post-operative radiographs are unreliable for assessing the quality of hip reduction. The level of experience, subspecialty, and geographical origin do not impact the radiographic assessment. Based on the present findings, we recommend performing post-operative magnetic resonance imaging rather than anteroposterior pelvis radiograph to assess the hip. Compared to standard radiographs, magnetic resonance imaging allows more reliable interpretation while decreasing radiation exposure.

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Authors and Affiliations

  1. Pediatric Orthopedic Department, Guangzhou Women and Children’s Medical Center, 9th Jinsui Road, Guangzhou, 510623, China

    BiCheng Yong, YiQiang Li, JingChun Li, HongWen Xu & Federico Canavese

  2. Pediatric Orthopedic Department, Regina Margherita Children’s Hospital, Torino, Italy

    Antonio Andreacchio

  3. Department of Orthopedic and Traumatology, University Hospital Vittorio Emanuele II, Catania, Italy

    Vito Pavone

  4. DRCI, University Hospital of Clermont Ferrand, Clermont Ferrand, France

    Bruno Pereria

  5. Pediatric Surgery Department, University Hospital Estaing, Clermont Ferrand, France

    Federico Canavese

Authors
  1. BiCheng Yong
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  2. YiQiang Li
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  3. JingChun Li
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  4. Antonio Andreacchio
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  5. Vito Pavone
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  6. Bruno Pereria
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  7. HongWen Xu
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  8. Federico Canavese
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Corresponding author

Correspondence to Federico Canavese.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

No patients were involved. This is a retrospective study of patient’s data, and an IRB approval was obtained (2017102307).

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Yong, B., Li, Y., Li, J. et al. Post-operative radiograph assessment of children undergoing closed reduction and spica cast immobilization for developmental dysplasia of the hip: does experience matter?. International Orthopaedics (SICOT) 42, 2725–2731 (2018). https://doi.org/10.1007/s00264-018-4038-0

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  • DOI: https://doi.org/10.1007/s00264-018-4038-0

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