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Reliability of radiographic signs for acetabular retroversion

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Abstract

Acetabular retroversion may contribute to femoroacetabular im**ement and lead to osteoarthritis of the hip. Retroversion has been measured on computed tomography scans. In recent years, assessment of acetabular version on anteroposterior pelvic views has gained increasing attention. We therefore aimed to determine the reliability of radiographic signs of acetabular retroversion and its association with the rater’s experience. Five orthopedic surgeons (o1 to o5) rated the crossover sign, ischial spine sign and posterior wall sign on X-rays of 40 hip joints. Also, we determined the rater’s experience in recognizing acetabular retroversion with a questionnaire and correlated intraobserver reliability to the calculated experience score. The intraobserver results were 0.325 (o1), 0.848 (o2), 0.684 (o3), 0.701 (o4), and 1.000 (o5) for the crossover sign, 0.750 (o1), 0.890 (o2), 0.593 (o3), 0.483 (o4), and 0.946 (o5) for the posterior wall sign; and 0.578 (o1), 0.680 (o2), 0.595 (o3), 0.375 (o4), and 0.800 (o5) for the ischial spine sign. Interobserver reliability was 0.514 for the crossover, 0.633 for the posterior, and 0.543 for the ischial spine sign wall. The experience sum score correlated to the kappa results for the crossover (r=0.527), posterior wall (r=0.738), and ischial spine sign (r=0.949). Assessing acetabular version on plain radiographs is subject to intra- and interindividual error and related to the observer’s individual experience.

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Authors and Affiliations

  1. Orthopaedic Surgery, University of Ulm, Ulm, Germany

    Thomas Kappe, Tugrul Kocak, Carl Neuerburg, Sabine Lippacher, Ralf Bieger & Heiko Reichel

Authors
  1. Thomas Kappe
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  2. Tugrul Kocak
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  3. Carl Neuerburg
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  4. Sabine Lippacher
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  5. Ralf Bieger
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Corresponding author

Correspondence to Thomas Kappe.

Appendix

Appendix

The 17-item questionnaire for determining experience with acetabular retroversion signs:

  1. 1.

    I am familiar with acetabular retroversion. yes/no

  2. 2.

    I am confident I can judge acetabular retroversion on a plain X-ray without additional imaging. yes/no

  3. 3.

    I am familiar with the crossover sign. yes/no

  4. 4.

    I am familiar with the posterior wall sign. yes/no

  5. 5.

    I am familiar with the ischial spine sign. yes/no

  6. 6.

    I use the crossover sign in my everyday practice. yes/no

  7. 7.

    I use the posterior wall sign in my everyday practice. yes/no

  8. 8.

    I use the ischial spine sign in my everyday practice. yes/no

  9. 9.

    I use the crossover sign to judge acetabular version in my everyday practice. yes/no

  10. 10.

    I use the posterior wall sign to judge acetabular version in my everyday practice. yes/no

  11. 11.

    I use the ischial spine sign to judge acetabular version in my everyday practice. yes/no

  12. 12.

    I know scientific publications describing or using the crossover sign. yes/no

  13. 13.

    I know scientific publications describing or using the posterior wall sign. yes/no

  14. 14.

    I know scientific publications describing or using the ischial spine sign. yes/no

  15. 15.

    Acetabular retroversion is associated with osteoarthritis of the hip. yes/no

  16. 16.

    Acetabular version can contribute to femoroacetabular im**ement. yes/no

  17. 17.

    Acetabular version can lead to pincer type femoroacetabular im**ement. yes/no

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Kappe, T., Kocak, T., Neuerburg, C. et al. Reliability of radiographic signs for acetabular retroversion. International Orthopaedics (SICOT) 35, 817–821 (2011). https://doi.org/10.1007/s00264-010-1035-3

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  • DOI: https://doi.org/10.1007/s00264-010-1035-3

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