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Area of Science:

  • Orthopedics
  • Pediatric Orthopedics
  • Radiology

Background:

  • Perthes disease treatment relies on radiographic classifications for outcome prediction.
  • Existing classifications include the Catterall and original lateral pillar methods.
  • The modified lateral pillar classification was proposed to improve reliability.

Purpose of the Study:

  • To compare the interobserver agreement and prognostic value of the Catterall, original lateral pillar, and modified lateral pillar classifications for Perthes disease.
  • To determine if the modified lateral pillar classification offers improved reliability over existing methods.

Main Methods:

  • 42 patients with Perthes disease underwent radiographic classification by 5 observers.
  • Classifications used were Catterall, original lateral pillar, and modified lateral pillar.
  • Interobserver agreement was assessed using weighted kappa statistics.
  • Prognostic value was evaluated by correlating classifications with femoral head sphericity at 5-year follow-up using Gamma statistics.

Main Results:

  • The original lateral pillar (kappa 0.49) and Catterall (kappa 0.43) classifications demonstrated moderate interobserver agreement.
  • The modified lateral pillar classification showed only fair agreement (kappa 0.40).
  • The original lateral pillar classification strongly correlated with 5-year radiographic outcome (mean γ=0.75).
  • The Catterall (mean γ=0.64) and modified lateral pillar (mean γ=0.55) classifications showed moderate associations.

Conclusions:

  • The Catterall and original lateral pillar classifications are suitable for clinical use due to sufficient interobserver agreement and prognostic value.
  • The modified lateral pillar classification, including the B/C borderline group, did not enhance interobserver agreement or prognostic capability.