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

Background Intraoperative fluoroscopy is commonly used to both guide the osteotomy and judge correction of the acetabular fragment in periacetabular osteotomy (PAO). Prior studies that have compared intraoperative fluoroscopic correction with postoperative radiographic correction were small studies that did not report intra-or interreader reliability. Questions/purposes (1) What is the correlation between intraoperative fluoroscopic correction in PAO compared with the correction seen on postoperative radiographs? (2) What is the reliability of radiographic measures of correction in PAO? Methods We performed a retrospective study of 121 patients (141 hips) who underwent PAO for symptomatic hip dysplasia at a tertiary referral center. Patients were included in the study if they had preoperative radiographs, intraoperative fluoroscopy, and minimum 6-week postoperative radiographs. Of the 272 PAO procedures performed in this time period, 61 patients who underwent PAO for retroversion and five patients with a history of Perthes disease were excluded as a result of the inability for these radiographic measures to judge fragment correction in PAOs for retroversion and the difficulty in measurement in post-Perthes deformity. Of the 206 PAOs performed for symptomatic acetabular dysplasia, 65 (32%) could not be analyzed because they lacked appropriate preoperative films, leaving 141 PAOs in 121 patients for analysis. The patients lacking appropriate preoperative films had them performed at an outside facility or had plain films that have since been destroyed. The lateral center-edge angle (LCEA) and acetabular index (AI) on the fluoroscopic views and postoperative radiographs were measured by two authors. The concordance between the amount of correction on intraoperative fluoroscopy and minimum 6-week postoperative measurements was analyzed using the concordance correlation coefficient (r c ) and a Bland-Altman analysis. Intra-and interrater reliability was calculated between measurements.

Section: Discussionmentioning

confidence: 91%

“…Multiple prior studies have reported on the reliability of measuring the LCEA and AI on plain radiographs. Studies on the interrater reliability of the LCEA reported intraclass correlation coefficients between 0.73 and 0.95 [12,14,16]. Intrarater reliability for these measures in published studies is between 0.80 and 0.87 [12,14,16].…”

Section: Discussionmentioning

confidence: 97%

Operative Fluoroscopic Correction Is Reliable and Correlates With Postoperative Radiographic Correction in Periacetabular Osteotomy

Wylie

Ross

Erickson

et al. 2017

“…Although efforts have been made to standardize the recommended FAI radiographs, few studies [10,12,18] have used radiographic findings to predict surgical outcome. Several studies [14,15] show a relationship between the Tönnis grade on plain radiographs and the presence of cartilage lesions in the hip at time of surgery.…”

Section: Discussionmentioning

confidence: 99%

Joint Space Predicts THA After Hip Arthroscopy in Patients 50 Years and Older

Philippon

Briggs

Carlisle

et al. 2013

196

152

Background All patients considering joint-preserving hip arthroscopy should be educated on the risk of THA after arthroscopy. The degree of radiographic osteoarthritis predicts subsequent THA. To provide patients with the best information, the best radiographic measure that predicts THA after hip arthroscopy should be identified. Questions/purposes We therefore determined if Tönnis grade, Kellgren-Lawrence grade, or joint space narrowing was superior in predicting THA after hip arthroscopy. Methods We retrospectively reviewed 203 patients 50 years of age or older treated with hip arthroscopy between

“…Thus, pre-and postoperative radiographs were measured as previously described [1,6,16] for the acetabular index, lateral centeredge angle (LCEA), anterior center-edge angle (ACEA), and Tönnis Grade of Osteoarthritis by an experienced clinician other than the operating surgeon (JAE). The reproducibility of these measures has been demonstrated as adequate to excellent in the literature [1,3,4,10,12,21]. The postoperative correction goals were defined as an acetabular index of 0°to 10°and center-edge angles (lateral and anterior) of 20°to 35°and remained consistent throughout the study.…”

Section: Variables Outcome Measures Data Sources and Biasmentioning

confidence: 99%

Preservation of the Rectus Femoris Origin During Periacetabular Osteotomy Does Not Compromise Acetabular Reorientation

Peters

Erickson

Anderson

et al. 2015

Background The early recovery period after periacetabular osteotomy (PAO) can be limited by pain and activity restrictions. Modifications of the Bernese PAO, including sparing the rectus tendon and discontinuing routine arthrotomy, may accelerate early postoperative recovery compared with the standard approach. Questions/purposes Does a modified approach for PAO (1) lead to improved pain control immediately after surgery; (2) lead to improved ambulation during the hospital stay; (3) lead to shorter stays, less blood loss, and shorter surgical times; and (4) compromise acetabular correction? Methods We retrospectively reviewed all 75 patients who underwent PAO for developmental dysplasia of the hip between August 2009 and May 2013. The control group included 44 consecutive patients who underwent a standard Bernese PAO with rectus takedown (RT). The study group consisted of 31 consecutive patients who underwent PAO using a modified rectus-sparing (RS) approach without routine arthrotomy. The groups were similar in age, body mass index, and American Society of Anesthesiologists score, but the RT group was comprised of a greater percentage of men than the RS group. Outcome variables were collected from patient charts and included inpatient pain, inpatient ambulation as well as length of stay, estimated blood loss, surgical time, and postoperative radiographic measurements. Cohen's f 2 was used to calculate the effect size in the regression analysis and effects were considered small for values \ 0.15, moderate for 0.15 to 0.34, and large for values [ 0.35. Results Patients who underwent PAO with a RS approach had less overall pain (RT median 4 versus RS median 2); however, the difference may not have been perceptible to the typical patient (p = 0.001, f 2 = 0.059). Patients treated with the RS approach ambulated similar distances during the hospital stay with a median 11 feet (interquartile range [IQR], 0-72.5) for the RT group and a median 30 feet (IQR, 0-100) for the RS group (p = 0.215, f 2 = 0.095).