reliability and stability of three common classifications for legg-calve-perthes disease

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Reliability and Stability of Three Common Classifications for Legg-Calve-Perthes Disease. Ki Hyuk Sung, MD Department of Orthopaedic Surgery Seoul National University Bundang Hospital. Introduction. Legg-Calve-Perthes disease (LCPD) - PowerPoint PPT Presentation

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  • Ki Hyuk Sung, MD

    Department of Orthopaedic SurgerySeoul National University Bundang HospitalReliability and Stability of Three Common Classifications for Legg-Calve-Perthes Disease

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    IntroductionLegg-Calve-Perthes disease (LCPD)An osteochondrosis that affects the proximal epiphysis of the femurTreatment : observation, nonsurgical containment using orthotic device, surgical containment procedure, salvage procedure

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    IntroductionThree common classification for LCPDCatterall classificationSalter and Thompson classificationHerring classification

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    Catterall I

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    Catterall II

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    Catterall III

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    Catterall IV

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    Type AType B

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    Herring A

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    Herring B

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    Herring C

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    IntroductionStability refers to the extent to which patients remain in the same classification level over time Poor stability indicates progression of the disease and more aggressive treatment is needed

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    IntroductionIf the range of stability of classification systems can be established, it would be possible to predict the course of the disease in the early stages

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    PurposeTo evaluate the reliability and stability of the classification system for LCPD.

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    Material and methods

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    Inclusion and exclusion criteria

    InclusionPatients with two or more sets of radiographs taken a minimum of 3 month intervals ExclusionPatients who visited only once before surgery (femoral osteotomy or pelvic osteotomy)Patients who classified as the reossification and remodeling stage at the initial visit

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    A consensus building session before radiographic measurement 36 radiographs and 3 raters for interrater and intrarater reliabilityChanges in classifications among initial rating, rating at early fragmentation, and final rating for stability

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    Statistical Methods Interrater and intrarater reliability ICC and 95% CI

    Stabilitypercentage agreement and ICC with 95% CI

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    Results

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    Demographics69 patients (60 males/ 9 females)

    Mean age: 6.5 years (2.3-11.3)

    Mean time between initial and final rating : 1.2 0.7 (SD) years

    A total 379 ratings (mean 5.5 2.1 per child)

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    Interrater reliability

    Classification systemICC95% CIHerring (Session 1)0.8940.825-0.940Herring (Session 2)0.8880.782-0.943Catterall (Session 1)0.8050.690-0.887Catterall (Session 2)0.7960.676-0.882Salter-Thompson (Session 1)0.6330.461-0.775Salter-Thompson (Session 2)0.7350.589-0.844

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    Intrarater reliability

    Classification systemICC95% CIHerring (Examiner 1)0.9070.809-0.953Herring (Examiner 2)0.9510.906-0.975Herring (Examiner 3)0.9080.770-0.958Catterall (Examiner 1)0.9150.840-0.955Catterall (Examiner 2)0.8130.655-0.901Catterall (Examiner 3)0.8100.659-0.899Salter-Thompson (Examiner 1)0.8230.658-0.909Salter-Thompson (Examiner 2)0.7510.562-0.865Salter-Thompson (Examiner 3)0.6590.424-0.811

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    Herring classification for initial and final rating of patients with Legg-Calve-Perthes diseaseInitial ratingFinal ratingABB/CCTotalA5193330B-243330B/C--1-1C---88Total54371469Percent agreement, 55%; intraclass correlation coefficient, 0.491 (95% CI, 0.116-0.709).

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    Herring classification for rating at early fragmentation and final rating of patients with Legg-Calve-Perthes diseaseRating at early fragmentationFinal ratingABB/CCTotalA261-9B-332439B/C--4-4C---99Total23971361Percent agreement, 79%; intraclass correlation coefficient, 0.714 (95% CI, 0.507-0.833).

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    Catterall classification for initial and final rating of patients with Legg-Calve-Perthes diseaseInitial ratingFinal ratingIIIIIIIVTotalI12429II--10919III--6713IV---2424Total12204265Percent agreement, 48%; intraclass correlation coefficient, 0.378 (95% CI, -0.006 to 0.634).

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    Catterall classification for rating at early fragmentation and final rating of patients with Legg-Calve-Perthes diseaseRating at early fragmentationFinal ratingIIIIIIIVTotalI----0II-1-23III--161026IV---2828Total01164057Percent agreement, 79%; intraclass correlation coefficient, 0.528 (95% CI, 0.274-0.705).

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    ConclusionThe classification of Herring et al has the highest interrater and intrarater reliability among three classification systems

    However, over 40% of the hip radiographs at the initial presentation, in particular, most of Herring group A patients were upgraded

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    ConclusionTherefore, we should keep in mind the possibility of surgical treatment for the patients who were over 8 years of age and initially graded as Herring group A

    SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

    Good morning, ladies and gentlemen. Please let me introduce myself. I am Chin youb Chung from the department of pediatric orthopedic surgery at Seoul national university Bundang hospital. It is a pleasure for me to give a presentation at this session. Thank you all for coming today to this presentation. My topic is validity and reliability of physical examinations and radiographic measurement evaluating patients with cerebral palsy for single event multilevel surgery.

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