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Reliability and Stability of Three Common Classifications for Legg-Calve-Perthes Disease

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)

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Reliability and Stability of Three Common Classifications for Legg-Calve-Perthes Disease

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  1. 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

  2. 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

  3. Introduction • Three common classification for LCPD • Catterall classification • Salter and Thompson classification • Herring classification

  4. Catterall I

  5. Catterall II

  6. Catterall III

  7. Catterall IV

  8. Type A Type B

  9. Herring A

  10. Herring B

  11. Herring C

  12. 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

  13. 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

  14. Purpose • To evaluate the reliability and stability of the classification system for LCPD.

  15. Material and methods

  16. 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

  17. 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

  18. Statistical Methods • Interrater and intrarater reliability • ICC and 95% CI • Stability • percentage agreement and ICC with 95% CI

  19. Results

  20. 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)

  21. Interrater reliability

  22. Intrarater reliability

  23. 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

  24. 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

  25. Thank you for your attention!

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