Interobserver and Intraobserver Reliability of Classification Systems for Radiographic Complications After Radial Head Arthroplasty
Although several classifications are used to assess radiographs following radial head arthroplasty (RHA), including the Popovic classification for radiolucency, the Chanlalit classification for stress shielding (SS), the Brooker classification for heterotopic ossification (HO), and the Broberg-Morre...
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| Veröffentlicht in: | The Journal of hand surgery (American ed.) 2023-05, Vol.48 (5), p.513.e1-513.e8 |
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| container_title | The Journal of hand surgery (American ed.) |
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| creator | Halvorson, Ryan T. Lalchandani, Gopal R. Cherches, Matthew F. Petit, Logan M. Lattanza, Lisa Lee, Nicolas H. Kandemir, Utku |
| description | Although several classifications are used to assess radiographs following radial head arthroplasty (RHA), including the Popovic classification for radiolucency, the Chanlalit classification for stress shielding (SS), the Brooker classification for heterotopic ossification (HO), and the Broberg-Morrey classification for radiocapitellar arthritis, little is known about the reliability of these classification systems. The purpose of this study was to determine the interobserver and intraobserver reliability of these classifications.
Six orthopedic surgeons at various levels of training reviewed elbow radiographs of 20 patients who underwent RHA and classified them according to the Popovic, Chanlalit, Brooker, and Broberg-Morrey classifications for radiolucency, SS, HO, and RHA, respectively. Four weeks after initial review, radiographic reviews were repeated. Reliability was measured using the Fleiss kappa and the intraclass correlation coefficient. Agreement was interpreted as none ( |
| doi_str_mv | 10.1016/j.jhsa.2021.11.028 |
| format | Article |
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Six orthopedic surgeons at various levels of training reviewed elbow radiographs of 20 patients who underwent RHA and classified them according to the Popovic, Chanlalit, Brooker, and Broberg-Morrey classifications for radiolucency, SS, HO, and RHA, respectively. Four weeks after initial review, radiographic reviews were repeated. Reliability was measured using the Fleiss kappa and the intraclass correlation coefficient. Agreement was interpreted as none (<0), slight (0.01–0.2), fair (0.21–0.4), moderate (0.41–0.6), substantial (0.61–0.8), and almost perfect (0.81–1) based on agreement among attending surgeons.
Among fellowship-trained attending surgeons, interobserver reliability was slight for SS (Chanlalit) and the categorical interpretation of radiolucency (Popovic), fair for radiocapitellar arthritis (Broberg-Morrey) and HO (Brooker), and substantial for the ordinal interpretation of radiolucency (Popovic). Residents had a higher interobserver reliability than attending physicians when using the Brooker classification. Mean intraobserver reliability was fair for SS (Chanlalit) and the categorical interpretation of radiolucency (Popovic), moderate for HO (Brooker) and radiocapitellar arthritis (Broberg-Morrey), and almost perfect for the ordinal interpretation of radiolucency (Popovic). Trainees had higher intraobserver reliability than attending surgeons using the SS (Chanlalit) classification.
The number of Popovic zones is reliable for communication between physicians, but caution should be taken with the Brooker, Chanlalit, Broberg-Morrey, and categorical interpretation of the Popovic classifications. All the classifications had better intraobserver than interobserver reliability.
Reliability of classification systems for radiographic complications after RHA is less than substantial except the number of zones of radiolucency; therefore, caution is required when drawing conclusions based on these classifications.</description><identifier>ISSN: 0363-5023</identifier><identifier>EISSN: 1531-6564</identifier><identifier>DOI: 10.1016/j.jhsa.2021.11.028</identifier><identifier>PMID: 35181176</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Arthritis - complications ; Arthritis - diagnostic imaging ; Arthritis - surgery ; Arthroplasty - adverse effects ; Heterotopic ossification ; Humans ; Observer Variation ; Ossification, Heterotopic - etiology ; radial head arthroplasty ; Radiography ; radiolucency ; reliability ; Reproducibility of Results ; stress shielding</subject><ispartof>The Journal of hand surgery (American ed.), 2023-05, Vol.48 (5), p.513.e1-513.e8</ispartof><rights>2023 American Society for Surgery of the Hand</rights><rights>Copyright © 2023 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-dd61ec450a0a0124bb6db31cd8c785235be96d7b7cf4165a6448a7da301143ad3</citedby><cites>FETCH-LOGICAL-c356t-dd61ec450a0a0124bb6db31cd8c785235be96d7b7cf4165a6448a7da301143ad3</cites><orcidid>0000-0002-7700-2464</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jhsa.2021.11.028$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35181176$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Halvorson, Ryan T.</creatorcontrib><creatorcontrib>Lalchandani, Gopal R.</creatorcontrib><creatorcontrib>Cherches, Matthew F.</creatorcontrib><creatorcontrib>Petit, Logan M.</creatorcontrib><creatorcontrib>Lattanza, Lisa</creatorcontrib><creatorcontrib>Lee, Nicolas H.</creatorcontrib><creatorcontrib>Kandemir, Utku</creatorcontrib><title>Interobserver and Intraobserver Reliability of Classification Systems for Radiographic Complications After Radial Head Arthroplasty</title><title>The Journal of hand surgery (American ed.)</title><addtitle>J Hand Surg Am</addtitle><description>Although several classifications are used to assess radiographs following radial head arthroplasty (RHA), including the Popovic classification for radiolucency, the Chanlalit classification for stress shielding (SS), the Brooker classification for heterotopic ossification (HO), and the Broberg-Morrey classification for radiocapitellar arthritis, little is known about the reliability of these classification systems. The purpose of this study was to determine the interobserver and intraobserver reliability of these classifications.
Six orthopedic surgeons at various levels of training reviewed elbow radiographs of 20 patients who underwent RHA and classified them according to the Popovic, Chanlalit, Brooker, and Broberg-Morrey classifications for radiolucency, SS, HO, and RHA, respectively. Four weeks after initial review, radiographic reviews were repeated. Reliability was measured using the Fleiss kappa and the intraclass correlation coefficient. Agreement was interpreted as none (<0), slight (0.01–0.2), fair (0.21–0.4), moderate (0.41–0.6), substantial (0.61–0.8), and almost perfect (0.81–1) based on agreement among attending surgeons.
Among fellowship-trained attending surgeons, interobserver reliability was slight for SS (Chanlalit) and the categorical interpretation of radiolucency (Popovic), fair for radiocapitellar arthritis (Broberg-Morrey) and HO (Brooker), and substantial for the ordinal interpretation of radiolucency (Popovic). Residents had a higher interobserver reliability than attending physicians when using the Brooker classification. Mean intraobserver reliability was fair for SS (Chanlalit) and the categorical interpretation of radiolucency (Popovic), moderate for HO (Brooker) and radiocapitellar arthritis (Broberg-Morrey), and almost perfect for the ordinal interpretation of radiolucency (Popovic). Trainees had higher intraobserver reliability than attending surgeons using the SS (Chanlalit) classification.
The number of Popovic zones is reliable for communication between physicians, but caution should be taken with the Brooker, Chanlalit, Broberg-Morrey, and categorical interpretation of the Popovic classifications. All the classifications had better intraobserver than interobserver reliability.
Reliability of classification systems for radiographic complications after RHA is less than substantial except the number of zones of radiolucency; therefore, caution is required when drawing conclusions based on these classifications.</description><subject>Arthritis - complications</subject><subject>Arthritis - diagnostic imaging</subject><subject>Arthritis - surgery</subject><subject>Arthroplasty - adverse effects</subject><subject>Heterotopic ossification</subject><subject>Humans</subject><subject>Observer Variation</subject><subject>Ossification, Heterotopic - etiology</subject><subject>radial head arthroplasty</subject><subject>Radiography</subject><subject>radiolucency</subject><subject>reliability</subject><subject>Reproducibility of Results</subject><subject>stress shielding</subject><issn>0363-5023</issn><issn>1531-6564</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFq3DAQhkVpaDZpX6CHomMvdjWSJTvQy7K0TSAQSNuzkKVxV4ttuZI2sOe8eLXsJscyh4Hh-3-Yj5CPwGpgoL7s6t02mZozDjVAzXj3hqxACqiUVM1bsmJCiUoyLi7JVUo7xkpKyHfkUkjoAFq1Is93c8YY-oTxCSM1s6PlEs3r5RFHb3o_-nygYaCb0aTkB29N9mGmPw8p45ToEAppnA9_olm23tJNmJbxTCW6HjKeADPSWzSOrmPexrCUtnx4Ty4GMyb8cN7X5Pf3b782t9X9w4-7zfq-skKqXDmnAG0jmSkDvOl75XoB1nW27SQXsscb5dq-tUMDShrVNJ1pnREMoBHGiWvy-dS7xPB3jynrySeL42hmDPukuRLshgsuuoLyE2pjSCnioJfoJxMPGpg-ytc7fZSvj_I1gC7yS-jTuX_fT-heIy-2C_D1BGD58slj1Ml6nC06H9Fm7YL_X_8_ubOYjA</recordid><startdate>202305</startdate><enddate>202305</enddate><creator>Halvorson, Ryan T.</creator><creator>Lalchandani, Gopal R.</creator><creator>Cherches, Matthew F.</creator><creator>Petit, Logan M.</creator><creator>Lattanza, Lisa</creator><creator>Lee, Nicolas H.</creator><creator>Kandemir, Utku</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7700-2464</orcidid></search><sort><creationdate>202305</creationdate><title>Interobserver and Intraobserver Reliability of Classification Systems for Radiographic Complications After Radial Head Arthroplasty</title><author>Halvorson, Ryan T. ; Lalchandani, Gopal R. ; Cherches, Matthew F. ; Petit, Logan M. ; Lattanza, Lisa ; Lee, Nicolas H. ; Kandemir, Utku</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-dd61ec450a0a0124bb6db31cd8c785235be96d7b7cf4165a6448a7da301143ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Arthritis - complications</topic><topic>Arthritis - diagnostic imaging</topic><topic>Arthritis - surgery</topic><topic>Arthroplasty - adverse effects</topic><topic>Heterotopic ossification</topic><topic>Humans</topic><topic>Observer Variation</topic><topic>Ossification, Heterotopic - etiology</topic><topic>radial head arthroplasty</topic><topic>Radiography</topic><topic>radiolucency</topic><topic>reliability</topic><topic>Reproducibility of Results</topic><topic>stress shielding</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Halvorson, Ryan T.</creatorcontrib><creatorcontrib>Lalchandani, Gopal R.</creatorcontrib><creatorcontrib>Cherches, Matthew F.</creatorcontrib><creatorcontrib>Petit, Logan M.</creatorcontrib><creatorcontrib>Lattanza, Lisa</creatorcontrib><creatorcontrib>Lee, Nicolas H.</creatorcontrib><creatorcontrib>Kandemir, Utku</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of hand surgery (American ed.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Halvorson, Ryan T.</au><au>Lalchandani, Gopal R.</au><au>Cherches, Matthew F.</au><au>Petit, Logan M.</au><au>Lattanza, Lisa</au><au>Lee, Nicolas H.</au><au>Kandemir, Utku</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interobserver and Intraobserver Reliability of Classification Systems for Radiographic Complications After Radial Head Arthroplasty</atitle><jtitle>The Journal of hand surgery (American ed.)</jtitle><addtitle>J Hand Surg Am</addtitle><date>2023-05</date><risdate>2023</risdate><volume>48</volume><issue>5</issue><spage>513.e1</spage><epage>513.e8</epage><pages>513.e1-513.e8</pages><issn>0363-5023</issn><eissn>1531-6564</eissn><abstract>Although several classifications are used to assess radiographs following radial head arthroplasty (RHA), including the Popovic classification for radiolucency, the Chanlalit classification for stress shielding (SS), the Brooker classification for heterotopic ossification (HO), and the Broberg-Morrey classification for radiocapitellar arthritis, little is known about the reliability of these classification systems. The purpose of this study was to determine the interobserver and intraobserver reliability of these classifications.
Six orthopedic surgeons at various levels of training reviewed elbow radiographs of 20 patients who underwent RHA and classified them according to the Popovic, Chanlalit, Brooker, and Broberg-Morrey classifications for radiolucency, SS, HO, and RHA, respectively. Four weeks after initial review, radiographic reviews were repeated. Reliability was measured using the Fleiss kappa and the intraclass correlation coefficient. Agreement was interpreted as none (<0), slight (0.01–0.2), fair (0.21–0.4), moderate (0.41–0.6), substantial (0.61–0.8), and almost perfect (0.81–1) based on agreement among attending surgeons.
Among fellowship-trained attending surgeons, interobserver reliability was slight for SS (Chanlalit) and the categorical interpretation of radiolucency (Popovic), fair for radiocapitellar arthritis (Broberg-Morrey) and HO (Brooker), and substantial for the ordinal interpretation of radiolucency (Popovic). Residents had a higher interobserver reliability than attending physicians when using the Brooker classification. Mean intraobserver reliability was fair for SS (Chanlalit) and the categorical interpretation of radiolucency (Popovic), moderate for HO (Brooker) and radiocapitellar arthritis (Broberg-Morrey), and almost perfect for the ordinal interpretation of radiolucency (Popovic). Trainees had higher intraobserver reliability than attending surgeons using the SS (Chanlalit) classification.
The number of Popovic zones is reliable for communication between physicians, but caution should be taken with the Brooker, Chanlalit, Broberg-Morrey, and categorical interpretation of the Popovic classifications. All the classifications had better intraobserver than interobserver reliability.
Reliability of classification systems for radiographic complications after RHA is less than substantial except the number of zones of radiolucency; therefore, caution is required when drawing conclusions based on these classifications.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35181176</pmid><doi>10.1016/j.jhsa.2021.11.028</doi><orcidid>https://orcid.org/0000-0002-7700-2464</orcidid></addata></record> |
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| ispartof | The Journal of hand surgery (American ed.), 2023-05, Vol.48 (5), p.513.e1-513.e8 |
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| source | MEDLINE; Elsevier ScienceDirect Journals Collection |
| subjects | Arthritis - complications Arthritis - diagnostic imaging Arthritis - surgery Arthroplasty - adverse effects Heterotopic ossification Humans Observer Variation Ossification, Heterotopic - etiology radial head arthroplasty Radiography radiolucency reliability Reproducibility of Results stress shielding |
| title | Interobserver and Intraobserver Reliability of Classification Systems for Radiographic Complications After Radial Head Arthroplasty |
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