Reliability and intraoperative validity of preoperative assessment of standardized plain radiographs in predicting bone loss at revision hip surgery.
BACKGROUND
The most challenging aspect of revision hip surgery is the management of bone loss. A reliable and valid measure of bone loss is important since it will aid in future studies of hip revisions and in preoperative planning. We developed a measure of femoral and acetabular bone loss associated with failed total hip arthroplasty. The purpose of the present study was to measure the reliability and the intraoperative validity of this measure and to determine how it may be useful in preoperative planning.


METHODS
From July 1997 to December 1998, forty-five consecutive patients with a failed hip prosthesis in need of revision surgery were prospectively followed. Three general orthopaedic surgeons were taught the radiographic classification system, and two of them classified standardized preoperative anteroposterior and lateral hip radiographs with use of the system. Interobserver testing was carried out in a blinded fashion. These results were then compared with the intraoperative findings of the third surgeon, who was blinded to the preoperative ratings. Kappa statistics (unweighted and weighted) were used to assess correlation. Interobserver reliability was assessed by examining the agreement between the two preoperative raters. Prognostic validity was assessed by examining the agreement between the assessment by either Rater 1 or Rater 2 and the intraoperative assessment (reference standard).


RESULTS
With regard to the assessments of both the femur and the acetabulum, there was significant agreement (p < 0.0001) between the preoperative raters (reliability), with weighted kappa values of >0.75. There was also significant agreement (p < 0.0001) between each rater's assessment and the intraoperative assessment (validity) of both the femur and the acetabulum, with weighted kappa values of >0.75.


CONCLUSIONS
With use of the newly developed classification system, preoperative radiographs are reliable and valid for assessment of the severity of bone loss that will be found intraoperatively.
Saleh
K J
KJ
University of Toronto, Ontario, Canada. saleh002@tc.umn.edu
Holtzman
J
J
Gafni
A
A
Saleh
L
L
Davis
A
A
Resig
S
S
Gross
A E
AE
D000077:Acetabulum / Q000000981:diagnostic imaging* / Q000473:pathology; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010024:Osteoporosis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index