The Eftekhar and Kerboul classifications in assessment of developmental dysplasia of the hip in adult patients. Measurement of inter- and intraobserver reliability

Abstract

Aim: To measure the inter-and intraobserver reliability of two radiologic classification systems in the evaluation of severity of osteoarthritis secondary to developmental dysplasia of the hip in adult patients and to compare these systems to historically published data on two more commonly used classification systems described by Crowe and by Hartofikakidis. Material and methods: Eighty-six dysplastic hips on 66 anteroposterior standard pelvic x-rays were rated according to the criteria of Eftekhar and Kerboul by three observers with different levels of clinical training. To assess intraobserver reliability, the measurement was repeated 3 months later. Statistical analysis was performed by calculating the weighted kappa correlation coefficient and the overall kappa coefficient. Results: Both classification systems showed a sufficient interobsever reliability, reaching a kappa coefficient of 0.73 for the system according to Eftekhar and 0.716 for the Kerboul classification system. Intraobserver reliability revealed a kappa coefficient of 0.778 for the Eftekhar system and 0.697 for the classification according to Kerboul. Conclusion: Both systems showed good inter-and intraobserver reliability for use in daily practice. However, they did not reach the known reliability of the grading systems published by Crowe and by Hartofikakidis. Because these systems are more frequently used, we would recommend one of them to grade the severity of osteoarthritis secondary to developmental dysplasia of the hip in adult patients instead of the ones described by Eftekhar or by Kerboul.

Absence of False Acetabulum is a Potent Indicator for Predicting the Use of Subtrochanteric Osteotomy in Total Hip Arthroplasty for High Dislocated Hips

“…Interestingly, another indicator, the absence of false acetabulum, also performed well and had a similar predictive accuracy with limb lengthening. As was described in Harto lakidis [4] and Eftekhar [34] classi cation systems, high dislocated hips were subdivided into two different types depending on the presence of false acetabulum. With the aid of those subtypes, they expected to predict the acetabular bone de ciencies encountered during THA and plan for reconstruction method.…”

In Brief: Crowe’s Classification: Arthroplasty in Developmental Dysplasia of the Hip

“…Others have examined the reliability of the classification systems of Eftekhar and Kerboul et al [1]. Although both classification systems showed sufficient reliability, they were less reliable when compared with Crowe's classification system.…”

“…Although both classification systems showed sufficient reliability, they were less reliable when compared with Crowe's classification system. Brunner et al recommended using the classification systems of Crowe et al or Hartofilakidis et al to assess the severity of hip dysplasia [1].…”

“…The main limitation of Crowe's classification system is the lack of correlation of the rating system with anatomy as (1) segmental deficiencies in the rim of the acetabulum superiorly, anteriorly, and posteriorly; (2) the amount of anteversion and the depth and opening, ie, the distance between the anterior and posterior rim of the true acetabulum; (3) the amount of acetabular bone stock superiorly, anteriorly, and posteriorly; and (4) the presence of osteophytes in the area of the true and false acetabula. Anatomic correlations are shown in Table 2.…”

Comparaison de la reproductibilité intra- et inter-observateurs des classifications de Crowe, Hartofilakidis et Cochin modifiée SOFCOT pour le diagnostic de la maladie luxante de hanche

“…Les classifications de Crowe (objective) et Hartofilakidis (subjective) sont les plus utilisées dans la litté-rature anglo-saxonne. Leur reproductibilité a été validée dans de nombreuses études [9][10][11], mais leur capacités à prédire les difficultés opératoires est remise en cause par de nombreux auteurs [7,12,13]. Parmi les classifications alternatives, on trouve celle proposée et évaluée par Gaston et al en 2009 [14] et celle publiée par Kerboull dès 1987 [2,15,16].…”