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Seoul National University Bundang Hospital Seoul National University Children’s Hospital *

Validity and Reliability of measuring femoral anteversion and neck-shaft angle in patients with cerebral palsy. Seoul National University Bundang Hospital Seoul National University Children’s Hospital *. Introduction.

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Seoul National University Bundang Hospital Seoul National University Children’s Hospital *

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  1. Validity and Reliability of measuring femoral anteversion and neck-shaft angle in patients with cerebral palsy Seoul National University Bundang Hospital Seoul National University Children’s Hospital *

  2. Introduction • Increased femoral anteversionand coxavalgaare common deformities associated with intoeing gait and unstable hips in CP, which need surgical correction • Physical examination and neck shaft angle measured on hip radiographs are primary tools evaluating femoral anteversion and coxavalga

  3. Introduction • Physical examinations measuring femoral anteversion include • Trochanteric prominence angle test (TPAT) • Hip internal rotation (IR) • Hip external rotation (ER) • CT measurement is accurate, but expensive and involves radiation exposure

  4. Purpose of Study • To assess the validity and reliability of physical examinations measuring femoral anteversion and neck shaft angle measured on hip AP radiographs • Concurrent validity • Intra- and interobserver reliability

  5. Materials and methods • Prospective study approved by IRB • 36 consecutive patients with CP scheduled for SEMLS • Mean age 11.0 years (SD 1.3) • M : F = 26 : 10 • 6 hemiplegia, 25 diplegia, and 5 quadriplegia • GMFCS I / II / III / IV / V 5 / 11 / 11 / 7 / 2 • Exclusion • Previous Op, trauma, infection, etc.

  6. TPAT

  7. Hip IR

  8. Hip ER

  9. NSA on X ray

  10. Femoral AV on CT Standard method for concurrent validity of P/E

  11. NSA on CT Standard method for concurrent validity of NSA on X-ray

  12. Validity • Physical exam measuring femoral AV • Correlation with femoral anteversion measured on 2D CT • NSA measured on X ray • Correlation with NSA measured on 3D MPR CT image

  13. Reliability • Interobserver reliability of physical exam using three orthopaedic surgeons on a single day • Intra- and interobserver reliability of NSA on X- ray • Repeated measurements with an interval of 3 wks

  14. Statistics • Validity • Pearson’s correlation coefficients • Reliability • Intraclass correlation coefficients (ICCs) • 2 way random effects, single measurement & absolute agreement • Multiple regression test • To predict the accurate femoral anteversion (CT) from physical exam

  15. Results

  16. Femoval AV on CT = 0.92 x TPAT - 3.2 (R2=0.829)

  17. Conclusions • TPAT and NSA on X ray showed clinically relevant validity and reliability compared with CT measurement • CT examination evaluating proximal femoral geometry could be replaced by physical examination and X ray in patients with CP, avoiding unnecessary radiation exposure

  18. This study has been published in JBJS-Am.

  19. Thank you !

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