Inter- and intra-observer variability of the Crowe and Hartofilakidis classification systems for congenital hip disease in adults

J Bone Joint Surg Br. 2008 May;90(5):579-83. doi: 10.1302/0301-620X.90B5.19724.


Our study evaluated the reliability of the Crowe and Hartofilakidis classification systems for developmental dysplasia of the hip in adults. The anteroposterior radiographs of the pelvis of 145 patients with 209 osteoarthritic hips were examined twice by three experienced hip surgeons from three European countries and the abnormal hips were rated using both classifications. The inter- and intra-observer agreement was calculated. Interobserver reliability was evaluated using weighted and unweighted kappa coefficients and for the Crowe classification, among the three pairs there was a minimum kappa coefficient with linear weighting of 0.90 for observers A and C and a maximum kappa coefficient of 0.92 for observers B and C. For the Hartofilakidis classification, the minimum kappa value was 0.85 for observers A and B, and the maximum value was 0.93 for observers B and C. With regard to intra-observer reliability, the kappa coefficients with linear weighting between the two evaluations of the same observer ranged between 0.86 and 0.95 for the Crowe classification and between 0.80 and 0.93 for the Hartofilakidis classification. The reliability of both systems was substantial to almost perfect both for serial measurements by individual readers and between different readers, although the information offered was dissimilar.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adult
  • Hip Dislocation, Congenital / classification*
  • Hip Dislocation, Congenital / diagnostic imaging
  • Humans
  • Observer Variation
  • Radiography
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Severity of Illness Index*