This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activities for this article:
 CME 4: October, November, December 2004
Pediatrics Test 6: Topics in Pediatric Orthopaedic Surgery
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Herring, J. A.
Right arrow Articles by Browne, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Herring, J. A.
Right arrow Articles by Browne, R.
Related Collections
Right arrow Pediatrics
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American) 86:2103-2120 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Legg-Calvé-Perthes Disease

Part I: Classification of Radiographs with Use of the Modified Lateral Pillar and Stulberg Classifications

John A. Herring, MD1, Hui Taek Kim, MD2 and Richard Browne, PhD1

1 Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75129. E-mail address for J.A. Herring: tony.herring{at}tsrh.org
2 Department of Orthopaedic Surgery, Pusan National University Hospital, 1Ga-10, Ami-Dong, Seo-Gu, Pusan 602-739, Korea

Investigation performed at the Texas Scottish Rite Hospital for Children, Dallas, Texas

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Texas Scottish Rite Hospital Research Fund and the Pediatric Orthopaedic Society of North America Huene Award. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

* The Legg-Perthes Study Group includes Peter Armstrong, John G. Birch, William Browning, Alvin H. Crawford, Peter DeLuca, Frederick Dietz, Ann Dzus, Keith Gabriel, Neil Green, Richard Gross, Curtis Gruel, William Herndon, John A. Herring, Brian Hotchkiss, Jay Jarvis, Charles Johnston, Vicki Kalen, John King, Dale Maples, Richard McIvor, Peter Meehan, Marc Moreau, Raymond Morrissy, Colin Moseley, Richard Nicol, George Rab, B. Stevens Richards, Thomas Rinsky, Andy Sullivan, George Thompson, Timothy Ward, Hugh Watts, Stuart Weinstein, David Yngve, and Seymour Zimbler. Diane Ramey was the study coordinator.

Background: Accurate and reliable radiographic classifications of the relative severity and outcome of Legg-Calvé-Perthes disease are essential in the study of that disease. As part of a prospective multicenter study*, we sought to define more clearly the lateral pillar classification of severity and the Stulberg classification of outcome; we sought especially to define the borderlines between classification groups.

Methods: We performed interobserver and intraobserver trials of the lateral pillar and Stulberg classifications using sets of twenty radiographs chosen from a prospective study of 345 hips. To establish reliable definitions of the lateral pillar classification, we added a new, intermediate group termed the B/C border group, which includes femoral heads with a thin or poorly ossified lateral pillar and those with a loss of exactly 50% of the original height of the lateral pillar. The resulting classification consists of four groups: A, B, B/C border, and C. In our application of the classification system of Stulberg et al., we defined a class-II femoral head as round and fitting within 2 mm of a circle on both anteroposterior and frog-leg lateral radiographs. We defined a Stulberg class-III femoral head as out of round by more than 2 mm on either view and a Stulberg class-IV femoral head as one with at least 1 cm of flattening of the weight-bearing articular surface. To assess interobserver and intraobserver agreement, we performed two trials of each classification with six orthopaedic surgeons reviewing twenty radiographs or pairs of radiographs.

Results: In the first trial of the lateral pillar classification, there was 81% agreement per radiograph and the average weighted kappa was 0.71. In the second trial, there was 85% agreement per radiograph and the weighted kappa averaged 0.79. Intraobserver reliability testing showed a 77% match between Trials 1 and 2, an average weighted kappa of 0.81, and an average generalizability coefficient of 0.91. In Trial 1 of the Stulberg classification, there was 91% agreement per radiograph and an average weighted kappa of 0.82. In Trial 2, there was 92% agreement per radiograph and an average weighted kappa of 0.82. Intraobserver reliability testing showed an 89% match between Trials 1 and 2, an average weighted kappa value of 0.88, and an average generalizability coefficient of 0.92.

Conclusions: The interobserver and intraobserver trials of these classifications produced kappa values and generalizability coefficients in the excellent range. The modified lateral pillar classification and the redefined Stulberg classification are sufficiently reliable and accurate for use in studies of Legg-Calvé-Perthes disease.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 J Am Acad Orthop SurgHome page
W. N. Sankar, J. Weiss, and D. L. Skaggs
Orthopaedic Conditions in the Newborn
J. Am. Acad. Ortho. Surg., February 1, 2009; 17(2): 112 - 122.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
S. B. Rosenfeld, J. A. Herring, and J. C. Chao
Legg-Calve-Perthes Disease: A Review of Cases with Onset Before Six Years of Age
J. Bone Joint Surg. Am., December 1, 2007; 89(12): 2712 - 2722.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. E. Domzalski, J. Glutting, J. R. Bowen, and A. G. Littleton
Lateral Acetabular Growth Stimulation Following a Labral Support Procedure in Legg-Calve-Perthes Disease
J. Bone Joint Surg. Am., July 1, 2006; 88(7): 1458 - 1466.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. S. Kocher and P. O. Newton
What's New in Pediatric Orthopaedics
J. Bone Joint Surg. Am., May 1, 2005; 87(5): 1171 - 1179.
[Full Text] [PDF]