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Rheumatol Int. 2016 Mar;36(3):371-6. doi: 10.1007/s00296-015-3361-7. Epub 2015 Oct 3.

The validity of a non-radiologist reader in identifying cam and pincer femoroacetabular impingement (FAI) using plain radiography.

Author information

1
Arthritis Research Centre of Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada. drcrat@gmail.com.
2
Brigham and Women's Hosp., Harvard Medical School, Boston, MA, USA. drcrat@gmail.com.
3
University of British Columbia, Vancouver, BC, Canada.
4
Arthritis Research Centre of Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.
5
Arthritis Research Centre of Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada. mbarber@arthritisresearch.ca.
6
Vancouver General Hospital, Vancouver, BC, Canada.

Abstract

The purpose of this study was to evaluate the validity and reliability of a radiographic diagnosis of femoroacetabular impingement (FAI) by a non-radiologist. Symptomatic FAI is prevalent and thought to be a cause of hip osteoarthritis. However, the diagnosis is often delayed by 1-2 years, in large part because radiographic findings are often subtle and clinicians have been unaware of their significance. The purpose of this study was to evaluate the validity of a radiographic diagnosis of FAI by a non-radiologist. A population-based sample of 701 subjects was recruited in Vancouver, Canada. For the current study, 50 subjects were selected-40 randomly from the population sample and 10 from an orthopedic practice with confirmed FAI. An anterior-posterior pelvis and bilateral Dunn radiographs were acquired and read by a fellowship-trained musculoskeletal radiologist and a third-year medical student who received basic training in radiographic signs of FAI. Three radiographic signs were evaluated: the lateral center edge angle, alpha angle and crossover sign. Validity was assessed using sensitivity and specificity, Bland-Altman limits of agreement and kappa. The sample contained 65% women (n = 31), was 62% Caucasian and 38% Chinese and had a mean age of 38.3 years. For correctly diagnosing FAI, the non-radiologist reader had a sensitivity of 0.83 and specificity of 0.87. Intra-rater κ value was 0.72, and prevalence-adjusted bias-adjusted κ was 0.76. This study provides evidence that a non-radiologist can accurately and reliably identify FAI on plain films.

KEYWORDS:

Femoroacetabular impingement; Hip osteoarthritis; Hip radiography; Validation

PMID:
26433895
PMCID:
PMC5762185
DOI:
10.1007/s00296-015-3361-7
[Indexed for MEDLINE]
Free PMC Article

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