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Radiographic reports in osteonecrosis of the hip in systemic lupus erythematosus
V Chaudhry-Ahlawalia1, D D Gladman, M B Urowitz
1University of Toronto Rheumatic Disease Unit, Toronto Hospital, Ontario, Canada.
Insights
The modified Marcus and Enneking classification reliably stages osteonecrosis of the femoral head in systemic lupus erythematosus patients. Radiologist reports are accurate for staging when interpreted by experts, but the classification needs modification for femoral side changes.
Area of Science:
- Orthopedics
- Rheumatology
- Radiology
Background:
- Osteonecrosis of the femoral head is a serious complication in patients with systemic lupus erythematosus.
- Accurate staging is crucial for treatment planning and prognosis.
Purpose of the Study:
- To evaluate the reliability and accuracy of the modified Marcus and Enneking classification for osteonecrosis of the femoral head in systemic lupus erythematosus patients.
- To assess its application to both direct radiograph reading and radiologist report interpretation.
Main Methods:
- Thirty hip radiographs from systemic lupus erythematosus patients with varying osteonecrosis degrees were reviewed.
- A panel of two rheumatologists and one orthopaedic surgeon independently graded radiographs using the modified Marcus and Enneking method.
- Inter-observer agreement was analyzed using kappa statistics.
Main Results:
- High agreement was found when grading original radiographs (weighted kappa = 0.88) and radiologist reports (kappa = 0.95).
- Agreement between direct radiograph reading and report interpretation was also substantial (weighted kappa = 0.86).
- Discrepancies often stemmed from the classification's omission of femoral side degenerative changes.
Conclusions:
- The radiologist's report, when interpreted by experts and containing critical details, can be reliably used for staging osteonecrosis of the femoral head.
- Modification of the Marcus and Enneking classification to include femoral side changes is recommended for improved accuracy.
Abstract:
The purpose of this study was to assess the reliability and accuracy of the modified Marcus and Enneking classification of osteonecrosis of the femoral head in patients with systemic lupus erythematosus when applied to the reading of the original radiographs and then applied to interpreting the radiologist's written report. Thirty anteroposterior radiographs of the hip from patients with systemic lupus erythematosus with varying degrees of osteonecrosis were selected and submitted to a panel of two rheumatologists and an orthopaedic surgeon who individually graded the radiographs using the modified Marcus and Enneking method. Agreement was determined by the kappa statistics. Identical staging was assigned in 21 of the 30 radiographs by all three observers, providing a weighted kappa of 0.88. Identical staging was assigned by all three observers in 26 of the 30 reports, giving a kappa of 0.95. There was agreement in the staging of 23 of the 30 radiographs by actual reading and the radiologist's report, with a weighted kappa of 0.86. Discordant gradings resulted primarily because the Marcus and Enneking method does not account for degenerative changes on the femoral side of the hip joint. The authors conclude that the radiologist's report can be used to stage osteonecrosis when interpreted by expert observers and when those reports contain all critical information required for staging. The authors recommend that the Marcus and Enneking classification be modified to include changes on the femoral side of the joint.