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The Effect of Clinical Knowledge and Surgical Experience on Treatment Choice in Legg–Calve–Perthes Disease: Intra-observer and Inter-observer Reliability Study

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Abstract

Aim

The aim of this study was to evaluate standardized hip radiographs, arthographs, demographic characteristics, physical examination findings, and their effects on treatment choices in leg–calve–perthes disease (LCPD). Intraobserver and interobserver realibility between orthopaedic residents, orthopaedic surgeons, and paediatric orthopaedic surgeons were also investigated.

Materials and Methods

47 LCPD patients were included this cross-sectional study. Six separate presentations including different variabilities (clinical findings, standard radiographs, and arthrographs) were evaluated by three different groups (residents, surgeons, paediatric orthopaedic surgeons) and were sent to the observers every other month by hiding patients’ personal information. Seven different treatment modalities were introduced for the best treatment modality. Intraobserver and interobserver reliability in these three groups were examined. Percentage aggreement (PA) and intraclass correlation coefficients (ICC) tests were used for this purpose.

Results

Treatment PA rates between presentations were 29.5–53.6% in residents, 38.3–60.4% in surgeons, and 39.1–59.8% in pediatric orthopaedic surgeons. Conservative methods were mostly preferred as treatment modality in all groups; followed by proximal femoral osteotomies. Pediatric orthopaedic surgeons preferred safe dislocation and femur head and/or neck reconstruction surgery 5–18 times more than residents and orthopaedic surgeons. Intraobserver reliability of treatment modalities was higher among the paediatric orthopaedic surgeons; the results were fair-good (0.483–0.763). Among residents and orthopaedic surgeons, ICC values were poor to good, respectively (− 0.080 to 0.636 and 0.263–0.643). Interobserver reliability among three groups was meanly good.

Conclusion

As surgical experience increases, both the compliance rates of the treatment modalities and the intra- and inter-group reliability are increased. Knowledge of the demographic data and clinical findings of patients besides hip radiographs or arthrographs increase treatment compliance in paediatric orthopaedic surgeons, however, cause changes in treatment modalities in residents. As surgical experience increases, more difficult surgeries such as safe dislocation and femoral head/neck reconstruction are preferred.

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References

  1. Catterall, A. (1971). The natural history of Perthes’ disease. Journal of Bone and Joint Surgery. British Volume,53, 37–53.

    Article  CAS  Google Scholar 

  2. Grasemann, H., Nicolai, R. D., Patsalis, T., & Hovel, M. (1997). The treatment of legg-calve-perthes disease. To contain or not to contain. Archives of Orthopaedic and Trauma Surgery,116, 50–54.

    Article  CAS  Google Scholar 

  3. Herring, J. A. (1994). The treatment of legg-calve-perthes disease. Current concepts review. Journal of Bone and Joint Surgery. American Volume,76, 448–458.

    Article  CAS  Google Scholar 

  4. Shah, H. (2014). Perthes disease: Evaluation and management. Orthopedic Clinics of North America,45(1), 87–97.

    Article  Google Scholar 

  5. Maning, M. (2013). Legg-calvé-perthes disease (LCPD). Principles of diagnosis and treatment. Orthopade,42(10), 891–902.

    Article  Google Scholar 

  6. Nelitz, M., Lippacher, S., Krauspe, R., & Reichel, H. (2009). Perthes disease: Current principles of diagnosis and treatment. Deutsches Arzteblatt International,106(31–32), 517–523.

    PubMed  PubMed Central  Google Scholar 

  7. Chaudhry, S., Phillips, D., & Feldman, D. (2014). Legg-calvé-perthes disease: An overview with recent literature. Bulletin of the Hospital for Joint Diseases,72(1), 18–27.

    PubMed  Google Scholar 

  8. de Sanctis, N., & Rondinella, F. (2000). Prognostic evaluation of legg-calvé-perthes disease by MRI. Part II: Pathomorphogenesis and new classification. Journal of Pediatric Orthopaedics,20(4), 463–470.

    PubMed  Google Scholar 

  9. Kotnis, R., Spiteri, V., Little, C., et al. (2008). Hip arthrography in the bassessment of children with developmental dysplasia of the hip and Perthes’ disease. Journal of Pediatric Orthopaedics B,17, 114–119.

    Article  Google Scholar 

  10. Ishida, A., Kuwajima, S. S., Laredo Filho, J., et al. (2004). Salter innominate osteotomy in the treatment of severe legg-calvé-perthes disease. Journal of Pediatric Orthopaedics,24, 257–264.

    Article  Google Scholar 

  11. Nakamura, J., Kamegaya, M., Saisu, T., et al. (2008). Hip arthrography under general anesthesia to refine the definition of hinge abduction in legg-calvé-perthes disease. Journal of Pediatric Orthopaedics,28, 614–618.

    Article  Google Scholar 

  12. Yoo, W. J., Choi, I. H., Cho, T. J., et al. (2009). Shelf acetabuloplasty for children with Perthes’ disease and reducible subluxation of the hip: Prognostic factors related to hipremodelling. Journal of Bone and Joint Surgery. British Volume,91, 1383–1387.

    Article  CAS  Google Scholar 

  13. Devalia, K. L., Wright, D., Sathyamurthy, P., et al. (2007). Role of preoperative arthrography in early perthes disease as a decisionmaking tool. Is it really necessary? Journal of Pediatric Orthopaedics B,16, 196–200.

    Article  Google Scholar 

  14. Katz, J. F. (1968). Arthrography in legg-calvé-perthes disease. Journal of Bone and Joint Surgery. American Volume,50, 467–472.

    Article  CAS  Google Scholar 

  15. Gallagher, J. M., Weiner, D. S., & Cook, A. J. (1983). When is arthrography indicated in legg-calvé-perthes disease? Journal of Bone and Joint Surgery. American Volume,65, 900–905.

    Article  CAS  Google Scholar 

  16. Podeszwa, D. A., Stanitski, C. L., Stanitski, D. F., Woo, R., & Mendelow, M. J. (2000). The effect of pediatric orthopaedic experience on interobserver and intraobserver reliability of the Herring lateral pillar classification of Perthes disease. Journal of Pediatric Orthopaedics,20, 562–565.

    Article  CAS  Google Scholar 

  17. Kalenderer, O., Agus, H., Ozcalabi, I. T., & Ozluk, S. (2005). The importance of surgeons’ experience on intraobserver and interobserver reliability of classifications used for Perthes disease. Journal of Pediatric Orthopaedics,25, 460–464.

    Article  Google Scholar 

  18. Agus, H., Kalenderer, O., Eryanlmaz, G., & Ozcalabi, I. T. (2004). Intraobserver and interobserver reliability of Caterall, Herring, Salter-Thompson and Stulberg classification systems in Perthes disease. Journal of Pediatric Orthopaedics,13, 166–169.

    Google Scholar 

  19. Altman, D. B. (1999). Practical statistics for medical research (pp. 398–408). Baton Raton: Chapman & Hall.

    Google Scholar 

  20. Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorial data. Biometrics,33, 159–174.

    Article  CAS  Google Scholar 

  21. Hefti, F., & Clarke, N. M. P. (2007). The management of legg-calvé-perthes disease: Is there a consensus? Journal of Children's Orthopaedics.,1, 19–25.

    Article  Google Scholar 

  22. Herring, J. A. (2014). Tachdjian’s pediatric orthopaedics. In H. K. W. Kim & J. A. Herring (Eds.), Chapter 17: Legg-calvé-perthes disease (5th ed., pp. 613–624). Philadelphia: Elsevier.

    Google Scholar 

  23. Çıtlak, A., Kerimoğlu, S., Baki, C., & Aydın, H. (2012). Comparison between conservative and surgical treatment in perthes disease. Archives of Orthopaedic and Trauma Surgery,132(1), 87–92.

    Article  Google Scholar 

  24. Leroux, J., Abu Amara, S., & Lechevallier, J. (2018). Legg-calvé-perthes disease. Orthopaedics & Traumatology: Surgery & Research,104(1S), 107–112.

    Google Scholar 

  25. Herrıng, J. A., Kım, H. T., & Browne, R. (2004). Legg-calvé-perthes disease: Part II: Prospective multicenter study of the effect of treatment on outcome. Journal of Bone and Joint Surgery. American Volume,86-A(10), 2121–2134.

    Article  Google Scholar 

  26. Noonan, K. J., Price, C. T., & Kupiszewski, S. J. (2001). Results of femoral varus osteotomy in children older than 9 years of age with perthes disease. Journal of Pediatric Orthopaedics,21(2), 198–204.

    CAS  PubMed  Google Scholar 

  27. Joseph, B., Nair, N. S., Narasimha Rao, K. L., Mulpuri, K., & Varghese, G. (2003). Optimal timing for containment surgery for perthes disease. Journal of Pediatric Orthopaedics,23, 601–606.

    Article  Google Scholar 

  28. Bennett, J. T., Stuecker, R., Smith, E., Winder, C., & Rice, J. (2002). Arthrographic findings in legg-calve-perthes disease. Journal of Pediatric Orthopaedics B,11, 110–116.

    Google Scholar 

  29. Axer, A., & Schiller, M. G. (1972). The pathogenesis of the early deformity of the capital femoral epiphysis in legg-calvé-perthes syndrome (L.C.P.S.). Clinical Orthopaedics,84, 106–115.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Tepecik Training and Research Hospital, Izmir, Turkey

    Serkan Erkus, Onder Kalenderer, Ali Turgut & Tayfun Bacaksiz

  2. Ege University School of Medicine ARGEFAR, Izmir, Turkey

    Kivanc Yuksel

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  1. Serkan Erkus
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  2. Onder Kalenderer
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  3. Ali Turgut
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Correspondence to Onder Kalenderer.

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Each of the authors states that there is no conflict of interest about this manuscript.

Ethical standard statement

This article has been approved by the ethics committee of our institution. The number of the approval was 2017/2.

Informed consent

In this study only physical examination findings and radiologic examinations of the patients were used, accordingly patient consent forms were not obtained.

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Erkus, S., Kalenderer, O., Turgut, A. et al. The Effect of Clinical Knowledge and Surgical Experience on Treatment Choice in Legg–Calve–Perthes Disease: Intra-observer and Inter-observer Reliability Study. JOIO 54, 477–485 (2020). https://doi.org/10.1007/s43465-020-00047-0

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  • DOI: https://doi.org/10.1007/s43465-020-00047-0

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