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Radiographic criteria in developmental dysplasia of the hip in late infancy, inter and intrareader agreement
Desiree Alam1, Souheil Hallit1,2,3,4, Joseph Mandour1,2
1School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.
Insights
Radiographic assessment of Developmental Dysplasia of the hip (DDH) shows reader variability, particularly in acetabular index measurements. Standardized training is crucial for consistent diagnosis in infants.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Developmental Dysplasia of the Hip (DDH)
Background:
- Developmental Dysplasia of the hip (DDH) is a common pediatric condition.
- Screening involves antero-posterior (AP) pelvic radiographs in infants aged 4-9 months.
- Key radiographic indicators include acetabular index, Shenton line, and femoral head ossification/symmetry.
Purpose of the Study:
- To assess the reliability and variability of radiographic indicators for DDH diagnosis among readers.
- To determine the mean age of femoral head ossification center appearance in the Lebanese population.
Main Methods:
- Analysis of 149 AP pelvic radiographs from infants aged 4-9 months.
- Three orthopedic residents (fellow, first-year, second-year) assessed radiographic criteria twice over three months.
- Inter-reader and intra-reader consistency were evaluated.
Main Results:
- Significant variability noted in acetabular index (AI) measurements between first-year and second-year residents.
- High inter- and intra-reader consistency observed for Shenton line integrity and femoral head ossification appearance.
- No single parameter sufficiently correlated with an acetabular angle > 30°.
- Average age of ossification center appearance in Lebanese infants: 5.57 months.
Conclusions:
- Reader variability, especially in acetabular index, necessitates standardized training for consistent radiographic assessment of DDH.
- A diagnostic approach integrating multiple parameters is recommended.
- Further research needed to refine protocols and evaluate individual parameter diagnostic strength.
Introduction:
Developmental Dysplasia of the hip (DDH) is a common pediatric disorder screened for by antero-posterior (AP) pelvic radiographs in infants aged between 4-9 months. We chose from the radiographic indicators commonly used in the diagnosis the acetabular index, the Shenton line and the ossification and symmetry of the femoral head to assess for their reliability and variability among readers. In addition, this study aimed to obtain the mean age of appearance of the ossification center of the femoral head in the Lebanese population.
Methods:
149 pelvic AP radiographs of children between 4 and 9 months of age were collected. The criteria were assessed by three experienced readers: one orthopedic surgery fellow resident, one first-year and one second-year orthopedic surgery residents twice separated by a three-month interval.
Results:
The bivariate analyses found a difference in the right Acetabular angle and left Acetabular angle significantly in the first- and second-year resident with a p < 0.01. No significant difference was found when comparing the readings of each reader independently for the other variables or with the fellow. We found a significant difference p = 0.047 when comparing the readings of the first-year resident and the fellow of the right AI. Whereas the left AI readings revealed significant differences between the fellow and the second-year resident (p = 0.008) and between the first and second-year residents (p < 0.001). Inter and intrareader consistency was high for the Shenton line rupture and the appearance of the ossification center on the femoral head but none of the parameters proved sufficient to significantly be associated with an acetabular angle> 30°. The average age of ossification center appearance in the Lebanese population was determined to be 5.57 months, aligning with global averages.
Conclusion:
These findings call for a diagnostic approach that integrates multiple parameters and focuses on the importance of standardized training to enhance the consistency of radiographic assessments. Further investigations should aim to establish more precise protocols and evaluate the diagnostic strength of individual parameters.
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