These authors sought to evaluate the intraobserver and interobserver agreement of the modified Walch classification system using both plain radiographs and computed tomography (CT).
Three fellowship-trained shoulder surgeons blindly and independently evaluated radiographs and CT scans of 100 consecutive shoulders (98 patients) and classified all shoulders according to the modified Walch classification in 4 separate sessions, each 4 weeks apart.
They included patients who had a diagnosis of primary osteoarthritis and who then underwent shoulder arthroplasty of some type. All patients had preoperative CT scans and axillary radiographs obtained routinely prior to surgery. There were 50 men (51%) and 48 women (49%).
They included patients who had a diagnosis of primary osteoarthritis and who then underwent shoulder arthroplasty of some type. All patients had preoperative CT scans and axillary radiographs obtained routinely prior to surgery. There were 50 men (51%) and 48 women (49%).
The first reading by the most senior observer on the basis of CT scans was used as the gold standard (distribution: A1, 18; A2, 12; B1, 20; B2, 25; B3, 22; C, 1; and D, 2).
The average intraobserver agreement for radiographs and CT scans was 0.73 (substantial; 0.72, 0.74, and 0.72) and 0.73 (substantial; 0.77, 0.69, and 0.72), respectively.
The average interobserver agreement was 0.55 (moderate; 0.61, 0.51, and 0.53) for radiographs and 0.52 (moderate; 0.63, 0.50, and 0.43) for CT scans.
There was a high degree of agreement between the CT scan and the axillary views for each of the three reviewers:
There was a high degree of agreement between the CT scan and the axillary views for each of the three reviewers:
Comment: This study is reassuring to those surgeons (including us) who find that an axillary view provides sufficient information to characterize the pathoanatomy and plan the surgical procedure for the great majority of patients coming to shoulder arthroplasty.
We note that CT scans expose the patient to 26 times the radiation of a standard set of plain radiographs and cost approximately $1000 more. Standardization of the axillary technique can yield highly reproducible views that can be easily analyzed for glenoid type, version, and the degree of decentering as demonstrated below
While it can be argued that CT scans with 3D reconstructions in the plane of the scapula are more precise than an axillary view, it has not been show that patients having this more complex imaging protocol obtain the better functional outcomes necessary to justify its substantial added expense and radiation exposure.
We note that CT scans expose the patient to 26 times the radiation of a standard set of plain radiographs and cost approximately $1000 more. Standardization of the axillary technique can yield highly reproducible views that can be easily analyzed for glenoid type, version, and the degree of decentering as demonstrated below
The use of standardized preoperative and postoperative axillary views provides a practical method for determining the effectiveness of surgical reconstruction.
While it can be argued that CT scans with 3D reconstructions in the plane of the scapula are more precise than an axillary view, it has not been show that patients having this more complex imaging protocol obtain the better functional outcomes necessary to justify its substantial added expense and radiation exposure.
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