International Orthopaedics

, Volume 42, Issue 11, pp 2725–2731 | Cite as

Post-operative radiograph assessment of children undergoing closed reduction and spica cast immobilization for developmental dysplasia of the hip: does experience matter?

  • BiCheng Yong
  • YiQiang Li
  • JingChun Li
  • Antonio Andreacchio
  • Vito Pavone
  • Bruno Pereria
  • HongWen Xu
  • Federico CanaveseEmail author
Original Paper



Closed reduction and spica cast immobilization are routinely used for young patients with developmental dysplasia of the hip with reducible hips. Our primary objective was to assess the interpretation quality of immediate post-operative pelvis radiographs after treatment.


A series of 28 randomly selected patients (30 hips) with pre- and post-operative pelvis radiographs and post-operative magnetic resonance imaging were included. Each was presented twice with an interval of two weeks, in alternating orders. Raters with different experience and specialties from different institutions rated the quality of reduction (hip in or out) after treatment.


Thirteen surgeons and three radiologists evaluated 30 hips (28 patients). Agreement was not satisfactory (κ = 0.12). Experienced clinicians demonstrated similar agreement to inexperienced raters (κ = 0.04). Consistency at a two week interval was moderate (κ = 0.48, percent of agreement at 82%). The mean number of errors from the two ratings were 8.6 ± 2.5 and 8.9 ± 2.7, respectively (P = 0.72). There was no significant difference between surgeons with different levels of experience; radiologists did better than surgeons, but the difference was insignificant. Raters from different institutions had similar performance in poor judgment.


Our results show poor concordance between observers and ratings. Post-operative radiographs are unreliable for assessing the quality of hip reduction. The level of experience, subspecialty, and geographical origin do not impact the radiographic assessment. Based on the present findings, we recommend performing post-operative magnetic resonance imaging rather than anteroposterior pelvis radiograph to assess the hip. Compared to standard radiographs, magnetic resonance imaging allows more reliable interpretation while decreasing radiation exposure.


DDH Closed reduction Radiographs MRI Reliability 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

No patients were involved. This is a retrospective study of patient’s data, and an IRB approval was obtained (2017102307).


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Pediatric Orthopedic DepartmentGuangzhou Women and Children’s Medical CenterGuangzhouChina
  2. 2.Pediatric Orthopedic DepartmentRegina Margherita Children’s HospitalTorinoItaly
  3. 3.Department of Orthopedic and TraumatologyUniversity Hospital Vittorio Emanuele IICataniaItaly
  4. 4.DRCIUniversity Hospital of Clermont FerrandClermont FerrandFrance
  5. 5.Pediatric Surgery DepartmentUniversity Hospital EstaingClermont FerrandFrance

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