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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)
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) • An osteochondrosis that affects the proximal epiphysis of the femur • Treatment : observation, nonsurgical containment using orthotic device, surgical containment procedure, salvage procedure
Introduction • Three common classification for LCPD • Catterall classification • Salter and Thompson classification • Herring classification
Type A Type B
Introduction • Stability 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
Introduction • If 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
Purpose • To evaluate the reliability and stability of the classification system for LCPD.
Inclusion and exclusion criteria • Inclusion • Patients with two or more sets of radiographs taken a minimum of 3 month intervals • Exclusion • Patients who visited only once before surgery (femoral osteotomy or pelvic osteotomy) • Patients who classified as the reossification and remodeling stage at the initial visit
A consensus building session before radiographic measurement • 36 radiographs and 3 raters for interrater and intrarater reliability • Changes in classifications among initial rating, rating at early fragmentation, and final rating for stability
Statistical Methods • Interrater and intrarater reliability • ICC and 95% CI • Stability • percentage agreement and ICC with 95% CI
Demographics • 69 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)
Conclusion • The 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
Conclusion • Therefore, 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
