Reliability of the modified lateral pillar classification for legg calvé perthes disease performed by a large group of international paediatric orthopaedic surgeons

International Perthes Study Group

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Purpose: The modified lateral pillar classification (mLPC) is used for prognostication in the fragmentation stage of Legg Calvé Perthes disease. Previous reliability assessments of mLPC range from fair to good agreement when evaluated by a small number of observers with pre-selected radiographs. The purpose of this study was to determine the inter-observer and intra-observer reliability of mLPC performed by a group of international paediatric orthopaedic surgeons. Surgeons self-selected the radiograph for mLPC assessment, as would be done clinically. Methods: In total, 40 Perthes cases with serial radiographs were selected. For each case, 26 surgeons independently selected a radiograph and assigned mLPC and 21 raters re-evaluated the same 40 cases to establish intra-observer reliability. Rater performance was determined through surgeon consensus using the mode mLPC as ‘gold standard’. Inter- observer and intra-observer reliability data were analysed using weighted kappa statistics. Results: The weighted kappa for inter-observer correlation for mLPC was 0.64 (95% confidence interval: 0.55 to 0.74) and was 0.82 (range: 0.35 to 0.99) for intra-observer correlation. Individual surgeon’s overall performance varied from 48% to 88% agreement. Surgeon mLPC performance was not influenced by years of experience (p = 0.51). Radiograph selection did not influence gold standard assignment of mLPC. There was greater agreement on cases of mild B hips and severe C hips. Conclusions: mLPC has low good inter-observer agreement when performed by a large number of surgeons with varied experience. Surgeons frequently chose different radiographs, with no impact on mLPC agreement. Further refinement is needed to help differentiate hips on the border of group B and C. Level of evidence III.

Original languageEnglish (US)
Pages (from-to)529-536
Number of pages8
JournalJournal of Children's Orthopaedics
Volume14
Issue number6
DOIs
StatePublished - 2020

Funding

This study was funded by three grants from the Pediatric Orthopaedic Society of North America, as well the Texas Scottish Rite Hospital for Children and the Gillette Children?s Foundation. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the content of this article. This study was funded by three grants from the Pediatric Orthopaedic Society of North America, as well the Texas Scottish Rite Hospital for Children and the Gillette Children’s Foundation. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the content of this article. JCL reports the International Perthes Study Group’s receipt of three awards from Pediatric Orthopaedic Society of North America (POSNA). This work was also partially funded by Texas Scottish Rite Hospital and the Gillette Children’s Foundation. JCL also reports being a member of the Board of Directors of the Legg Calvé Perthes Foundation (this is a volunteer position with no financial compensation), and receiving grant funding from Gillette Children’s Foundation and POSNA to develop a new animal model of Perthes disease, outside the submitted work. The other authors declare no conflict of interest.

Keywords

  • Inter-observer reliability
  • Intra-observer reliability
  • Lateral pillar classification
  • Legg calvé perthes disease
  • Paediatric hip

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

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