Interobserver and intraobserver reliability of a new radiological classification for femoroacetabular impingement syndrome

Purpose: Radiological evaluation of femoroacetabular impingement is based on single-plane parameters such as the alpha angle or the center edge angle, or complex software reconstruction. A new simple classification for cam and pincer morphologies, based on a two-plane radiological evaluation, is presented in this study. The determination of the intraobserver and interobserver reliability of this new classification is the purpose of this study. Methods: We retrospectively reviewed the three-view hip study in patient undergoing hip arthroscopy for FAI syndrome between October 2015 and April 2016. Any case having protrusio acetabuli, coxa profunda or which has undergone previous osteotomic surgery was excluded. Five observers used our proposed classification to identify three different stages for the cam and pincer morphologies. Inter- and intraobserver agreement of classification was determined using average pairwise Cohen's kappa coefficient. Results: The interobserver agreement for the pincer and cam morphologies was excellent. For the pincer morphology classification, the average Kappa agreement was 0.838 (range 0.764-0.944). For the cam morphology, the average pairwise Cohen's kappa coefficient was 0.846 (range 0.734-0.929). The intraobserver agreement was excellent as well. The average percent pairwise agreement was 0.870 and 0.845 for pincer and cam type, respectively. Conclusions: The new classification system shows excellent levels of inter- and intraobserver agreement for both deformities. This classification is demonstrated to be a useful tool in planning hip arthroscopy. Further studies are needed to correlate the classification itself with specific intraoperative findings.