Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment

J-M Kwak; E Kholinne; Y Sun; A M Alhazmi; K-H Koh; I-H Jeon

doi:10.1016/j.joca.2019.03.004

Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment

Osteoarthritis Cartilage. 2019 Jul;27(7):1057-1063. doi: 10.1016/j.joca.2019.03.004. Epub 2019 Mar 25.

Authors

J-M Kwak¹, E Kholinne², Y Sun³, A M Alhazmi¹, K-H Koh¹, I-H Jeon⁴

Affiliations

¹ Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea.
² Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.
³ Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
⁴ Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea. Electronic address: jeonchoi@gmail.com.

PMID: 30922981
DOI: 10.1016/j.joca.2019.03.004

Abstract

Objectives: To develop a staging system that could better reflect symptoms by the spurs quantification in the fossa and joint space narrowing using computed tomography (CT) for elbow arthritis and to evaluate its reproducibility with multiple readers.

Methods: This retrospective study evaluated 81 cases of primary elbow osteoarthritis using both plain radiography and CT. Qualitative and quantitative analyses were independently performed by four orthopedic surgeons using previous and newly proposed staging systems. The reproducibility of the new system was analyzed with intraclass correlation coefficients (ICC). Correlations between symptoms and radiologic classification were assessed using Pearson's correlation coefficient (PCC).

Results: The interobserver agreement (1) and intraobserver agreement (2) among the four evaluators was present by ICC. (1) The system of Hastings and Rettig [first observation, 0.544 (95% confidence interval (CI), 0.436-0.649); second observation, 0.582 (95% CI, 0.478-0.682)] and Broberg and Morrey's staging system [first observation, 0.620 (95% CI, 0.521-0.714); second observation, 0.656 (95% CI, 0.562-0.743)] showed substantial and moderate retrospective agreement, whereas the CT-based staging system showed almost perfect agreement [first observation, 0.867 (95% CI, 0.820-0.906); second observation, 0.909 (95% CI, 0.875-0.936)]. (2) The intraobserver agreement was almost perfect in the Brogerg and Morrey's and CT-based staging systems. CT-based staging showed high correlation with visual analogue scale (PCC 0.754, P < 0.001) and Mayo elbow performance score (PCC -0.614, P < 0.001) and moderate correlation with range of motion (PCC -0.458, P < 0.001).

Conclusions: CT-based staging system was highly reproducible and clinically feasible than previous plain radiograph-based staging systems.

Keywords: Arthritis; CT-based; Classification; Elbow; Grading system; Staging.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Cohort Studies
Elbow Joint / diagnostic imaging*
Elbow Joint / pathology
Female
Humans
Male
Middle Aged
Observer Variation
Osteoarthritis / classification
Osteoarthritis / diagnostic imaging*
Osteoarthritis / pathology
Pain Measurement*
Physical Examination / methods
Radiography / methods
Range of Motion, Articular / physiology*
Retrospective Studies
Severity of Illness Index
Tomography, X-Ray Computed / methods*