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· DOS Abstracts
Low inter-observer agreement among experienced
shoulder surgeons assessing overstuffing of glenohu-
meral resurfacing hemiarthroplasty based on plain ra-
diographs
Nicolai Sandau, Stig Brorson, Bo S. Olsen, Anne Kathrine Sørensen, Steen L. Jen-
sen, Kim Schantz, Janne Ovesen, Jeppe V. Rasmussen
Dept. of Orthopedic Surgery, Herlev & Gentofte Hospital
Background:
Visual evaluation of post-implant radiographs is often used to as-
sess the restoration of glenohumeral joint anatomy after shoulder replacement
surgery and is a part of the decision-making process, when evaluating patients
with inferior clinical results. However, information about the reliability of such a
visual evaluation is lacking.
Purpose / Aim of Study:
The aim of this study was to investigate the inter-
and intra-observer agreement among experienced shoulder surgeons assessing
overstuffing, implant positioning and sizing following resurfacing hemiarthro-
plasty (RHA) using plain standardized radiographs.
Materials and Methods:
Six experienced shoulder surgeons independently
classified implant inclination angle, sizing of the implant and if the joint seemed
overstuffed, in 219 cases of post- implant radiographs. All cases were classified
twice three weeks apart. Only radiographs with an anterior-posterior projection
with a freely visible joint space were used. Non-weighted Cohen’s kappa values
were calculated for each coder pair and the mean used as an estimate of the
overall inter-observer agreement.
Findings / Results:
The overall inter-observer agreement for implant sizing
(kappa: 0.48 and 0.41) and inclination angle was moderate in both rounds (kap-
pa: 0.46 and 0.44), but only fair agreement was found concerning the evalua-
tion for stuffing of the joint (kappa: 0.24 and 0.28). Intra-observer agreement
for implant size and stuffing ranged from fair to substantial while the agreement
for inclination was moderate to substantial.
Conclusions:
We advise caution using conclusions based on this method in
the decision-making process regarding revision surgery and for using the term
overstuffing as an explanation for poor functional outcome.
No conflicts of interest reported
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