Tag Archive for: Tonnis classification

Reliability of a New Radiographic Classification System for Developmental Dysplasia of the Hip

Volume 6 | Issue 1 | Jan – April 2020 | Page: 16-19 | B. Pasupathy, M. Sathish


Authors : B. Pasupathy [1], M. Sathish [1]

[1] Department of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai, TamilNadu India.

Address of Correspondence
Dr. M.Sathish,
Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai Tamil Nadu India.
E-mail: drsathishmuthu@gmail.com


Abstract

The Tonnis radiographic classification for developmental dysplasia of the hip (DDH) has been widely used for grading the severity of the disease. By definition, this method requires the presence of an ossification centre, which can be delayed in appearance and eccentric in location at times. The International Hip Dysplasia Institute (IHDI) classification, a new classification system recently developed by the IHDI, answers the scenario unanswered by the Tonnis classification. This study aimed to validate its reliability in evaluating DDH with an ossification center and to compare the 2 classifications in evaluating all DDH hips. In total, the pelvic radiographs of 92 DDH patients (115 hips) between the ages of 6 and 48 months between 2014 and 2017 were assessed by 3 observers retrospectively using the 2 classifications. Intraobserver and interobserver variations were evaluated using Cohen’s kappa method and graded with Munro’s correlation strength categories. Both classifications showed excellent intraobserver and interobserver reliability. However, the IHDI demonstrated more interobserver reliability, especially for evaluating DDH without an ossification center. The IHDI classification exhibited good practicability in classifying the radiographic severity of DDH compared to the Tonnis classification, particularly in hips without an ossification center. Therefore, the IHDI classification seems to be the expanded version of the Tonnis classification and can be used as a reliable tool in the management of the early stages of DDH to stage the disease and plan treatment accordingly.
Keywords: Tonnis classification, IHDI classification, DDH.


References 

1. Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet 2007;369:1541-52.
2. Orak MM, Onay T, Çağırmaz T, Elibol C, Elibol FD, Centel T, et al. The reliability of ultrasonography in developmental dysplasia of the hip: How reliable is it in different hands? Indian J Orthop 2015;49:610-4.
3. Atalar H, Dogruel H, Selek H, Tasbas BA, Bicimoglu A, Gunay C, et al. A comparison of ultrasonography and radiography in the management of infants with suspected developmental dysplasia of the hip. Acta Orthop Belg 2013;79:524-9.
4. Tönnis D. Indications and time planning for operative interventions in hip dysplasia in child and adulthood. Z Orthop Ihre Grenzgeb 1985;123:458-61.
5. Boniforti FG, Fujii G, Angliss RD, Benson MK. The reliability of measurements of pelvic radiographs in infants. J Bone Joint Surg Br 1997;79:570-5.
6. Upasani VV, Bomar JD, Parikh G, Hosalkar H. Reliability of plain radiographic parameters for developmental dysplasia of the hip in children. J Child Orthop 2012;6:173-6.
7. William TT, John BT. Classic. Translation: Hilgenreiner on congenital hip dislocation. J Pediatr Orthop 1986;6:202-14.
8. Rosen A, Gamble JG, Vallier H, Bloch D, Smith L, Rinsky LA, et al. Analysis of radiographic measurements as prognostic indicators of treatment success in patients with developmental dysplasia of the hip. J Pediatr Orthop B 1999;8:118-21.
9. Bolland BJ, Wahed A, Al-Hallao S, Culliford DJ, Clarke NM. Late reduction in congenital dislocation of the hip and the need for secondary surgery: Radiologic predictors and confounding variables. J Pediatr Orthop 2010;30:676-82.
10. Narayanan U, Mulpuri K, Sankar WN, Clarke NM, Hosalkar H, Price CT, et al. Reliability of a new radiographic classification for developmental dysplasia of the hip. J Pediatr Orthop 2015;35:478-84.
11. Judd J, Clarke NM. Treatment and prevention of hip dysplasia in infants and young children. Early Hum Dev 2014;90:731-4.
12. Alsaleem M, Set KK, Saadeh L. Developmental dysplasia of hip: A review. Clin Pediatr (Phila) 2015;54:921-8.
13. Ramo BA, De La Rocha A, Sucato DJ, Jo CH. A new radiographic classification system for developmental hip dysplasia is reliable and predictive of successful closed reduction and late pelvic osteotomy. J Pediatr Orthop 2018;38:16-21.
14. Viera AJ, Garett JM. Understanding interobserver agreement: The Kappa statistic. Fam Med 2005;27:360-3.
15. Kotlarsky P, Haber R, Bialik V, Eidelman M. Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop 2015;6:886-901.
16. Murphy RF, Kim YJ. Surgical management of pediatric developmental dysplasia of the hip. J Am Acad Orthop Surg 2016;24:615-24.
17. Roposch A, Odeh O, Doria AS, Wedge JH. The presence of an ossific nucleus does not protect against osteonecrosis after treatment of developmental dysplasia of the hip. Clin Orthop Relat Res 2011;469:2838-45.
18. Roposch A, Wedge JH, Krahn MD. The role of the ossific nucleus in the treatment of established hip dislocation. Clin Orthop Relat Res 2006;449:295-302.


How to Cite this Article: Pasupathy B, Sathish M.| Reliability of a New Radiographic Classification System for Developmental Dysplasia of the Hip.| International Journal of Paediatric Orthopaedics | Jan-April 2020; 6(1): 16-19.

(Abstract)      (Full Text HTML)      (Download PDF)