Yet, another difficulty may rise when parameters from different grades are found in a single radiograph e.g. It has been criticized for being unclear and having overlapping parameters. A cardinal drawback of the traditional Tönnis Classification System is it’s subjectivity. First, several studies have reported questionable inter-observer and intra-observer reliability. However, despite its extensive use in clinical practice and medical literature, the traditional Tönnis Classification System has some drawbacks. The literature generally supports hip preservation for hips graded as Tönnis 0 and 1, and replacement for hips graded Tönnis 2 and 3. The traditional Tönnis Classification System is commonly used to classify the severity of osteoarthritis. Radiographic assessment provides essential information concerning the diagnosis and treatment of osteoarthritis. Therefore, a reliable evaluation of the degree of osteoarthritis is necessary for optimizing patient outcomes. Efforts to preserve the hip joint are hindered by the presence of osteoarthritis. The presence of osteoarthritis is a critical factor in a surgeon’s decision between the two options. ConclusionĪ simplified binary Tönnis Classification System demonstrates better reliability and clinical implementation than the traditional Tönnis Classification System.įor hip joint pathologies, two major operative treatments exist: hip preservation and hip replacement. When the traditional Tönnis Classification System was dichotomized, the capture rate was 84%. On average, the Binary Tönnis Classification System correctly captured 87% of cases. For the proposed Binary Tönnis Classification System, both inter-observer and intra-observer reliability demonstrated excellent values, (κ = 0.858 and 0.928, respectively). For the traditional Tönnis Classification System, the weighted κ showed a fair inter-observer reliability (κ = 0.474) and excellent intra-observer reliability (κ mean = 0.866). The study sample contained 40 anterosuperior hip radiographs. A multi-rater κ was calculated using the weighted Fleiss method. Intra- and inter-observer reliability values for both the systems were calculated using the Cohen’s κ coefficient. Five fellowship-trained hip surgeons from a single center, in a fully crossed design, analyzed and graded all the radiographs utilizing the traditional Tönnis Classification System and the proposed Binary Tönnis Classification System. All radiographs were randomized and blinded by a non-observer. Patients were excluded if they had prior hip surgeries or conditions. Patients were included in this study if they were between 35 and 60 years old. Methodsįorty consecutive patients were selected to participate in this study. Our hypothesis is that the proposed Binary Tönnis Classification System will have better reliability and agreement for surgical decision-making. The purpose of this study is to (1) compare the inter-observer and intra-observer reliability of the traditional Tönnis Classification System and a simplified Binary Tönnis Classification System for hip osteoarthritis and to (2) evaluate the clinical applicability of both systems. A two-grade classification could potentially be more reliable. The traditional Tönnis Classification System has inherent drawbacks as it is vulnerable to the subjectivity of a four-grade system.
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