Riddle Daniel L, Jiranek William A, Hull Jason R
Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
Orthopedics. 2013 Jan;36(1):e25-32. doi: 10.3928/01477447-20121217-14.
Most orthopedic surgeons do not routinely use radiographic classification systems to grade the extent of joint space narrowing in patients considered for total knee arthroplasty. The authors compared the validity and reliability of radiographic measures of tibiofemoral osteoarthritis by 2 experienced and 2 inexperienced orthopedic surgeons on individuals who subsequently underwent total knee arthroplasty. The Kellgren-Lawrence and the Osteoarthritis Research Society International classification systems were used by all surgeons to score the radiographs in 116 individuals in the Osteoarthritis Initiative, a federally funded cohort study of individuals with or at risk of knee osteoarthritis. Validity was judged based on comparison with the criterion centrally adjudicated consensus measures obtained by Osteoarthritis Initiative investigators. Weighted kappa, a chance corrected agreement index, was used to describe validity and reliability. Validity and intrarater reliability were substantial to almost perfect for 1 experienced and 1 inexperienced surgeon, with weighted kappas ranging from 0.76 to 0.96 for the surgical knees. The other experienced and inexperienced surgeons demonstrated moderate to substantial validity, with weighted kappas ranging from 0.43 to 0.70 and lower intrarater reliability. Interrater reliability was generally less than intrarater reliability. With minimal training, some surgeons can obtain valid and reliable measurements of knee osteoarthritis status in individuals who eventually undergo total knee arthroplasty. Measurement quality does not appear to be dependent on extent of surgeon experience. Some surgeons require additional training to become proficient in the radiographic classification systems, and future research should examine this issue.
大多数骨科医生在考虑为患者进行全膝关节置换术时，并不常规使用影像学分类系统来评估关节间隙变窄的程度。作者比较了2名经验丰富和2名经验不足的骨科医生对随后接受全膝关节置换术的个体进行胫股骨关节炎影像学测量的有效性和可靠性。所有外科医生都使用Kellgren-Lawrence和国际骨关节炎研究学会分类系统，对骨关节炎倡议组织中116名个体的X光片进行评分。骨关节炎倡议组织是一项由联邦资助的针对患有膝关节骨关节炎或有患膝关节骨关节炎风险个体的队列研究。有效性是通过与骨关节炎倡议组织研究人员获得的经中央判定的共识测量标准进行比较来判断的。加权kappa值（一种考虑了机遇因素的一致性指数）用于描述有效性和可靠性。对于1名经验丰富和1名经验不足的外科医生，有效性和评分者内信度在很大程度上接近完美，手术膝关节的加权kappa值范围为0.76至0.96。另一位经验丰富和经验不足的外科医生表现出中等至较高的有效性，加权kappa值范围为0.43至0.70，评分者内信度较低。评分者间信度通常低于评分者内信度。经过最少的培训，一些外科医生能够在最终接受全膝关节置换术的个体中获得关于膝关节骨关节炎状况的有效且可靠的测量结果。测量质量似乎并不取决于外科医生的经验程度。一些外科医生需要额外的培训才能熟练掌握影像学分类系统，未来的研究应该审视这个问题。
