title: Radiographic assessment of uncemented total hip arthroplasty: reliability of the Engh Grading Scale.
abstract: BACKGROUND
  Radiographic evaluation has a prominent place in the follow-up of long-term results of uncemented total hip arthroplasty (THA). The most prominent scale reported in studies is the Engh Grading Scale, but there is a lack of literature on the reliability of the scale.
  
  
  METHODS
  We evaluated intra- and interrater reliability of the Engh Grading System for uncemented THA using 26 follow-up radiographs of patients who had primary uncemented THAs. Four evaluators with different skill levels and specialties participated: 2 arthroplasty surgeons, an orthopedic resident and a radiologist. Reliability was measured using a weighted κ coefficient for paired comparisons among the evaluators.
  
  
  RESULTS
  Intrarater reliability was dependent on the skill and specialty of the evaluator, with the highest values achieved for the arthroplasty surgeons (κ = 0.52 and κ = 0.68) and the lowest values for the radiologist (κ = 0.14). Interrater reliability was comparable among participants, regardless of skill or specialty, and rated a moderate level of reliability (κ = 0.29-0.41) for all pairings.
  
  
  CONCLUSIONS
  The Engh Grading Scale appears to be reliable when used by a single, experienced arthroplasty surgeon. Caution must be exercised when multiple raters are used, regardless of experience, as the interrater reliability achieved lower ratings.
authors: Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.
authors: Susan W
authors: SW
authors: Muir
authors: Aziz
authors: A
authors: Al-Ahaideb
authors: John
authors: J
authors: Huckell
authors: Mary Ann
authors: MA
authors: Johnson
authors: D Bill C
authors: DB
authors: Johnston
authors: Lauren A
authors: LA
authors: Beaupre
references: J Bone Joint Surg Am. 2008 Sep;90(9):1848-54
references: 18762643
references: Clin Orthop Relat Res. 1996 Jun;(327):238-46
references: 8641069
references: J Arthroplasty. 2000 Feb;15(2):183-6
references: 10708083
references: Clin Orthop Relat Res. 1990 Aug;(257):107-28
references: 2199114
references: J Arthroplasty. 2003 Dec;18(8):954-62
references: 14658097