Reliability of radiographic signs for acetabular retroversion

Acetabular retroversion may contribute to femoroacetabular impingement and lead to osteoarthritis of the hip. Retroversion has been measured on computed tomography scans. In recent years, assessment of acetabular version on anteroposterior pelvic views has gained increasing attention. We therefore aimed to determine the reliability of radiographic signs of acetabular retroversion and its association with the rater’s experience. Five orthopedic surgeons (o1 to o5) rated the crossover sign, ischial spine sign and posterior wall sign on X-rays of 40 hip joints. Also, we determined the rater’s experience in recognizing acetabular retroversion with a questionnaire and correlated intraobserver reliability to the calculated experience score. The intraobserver results were 0.325 (o1), 0.848 (o2), 0.684 (o3), 0.701 (o4), and 1.000 (o5) for the crossover sign, 0.750 (o1), 0.890 (o2), 0.593 (o3), 0.483 (o4), and 0.946 (o5) for the posterior wall sign; and 0.578 (o1), 0.680 (o2), 0.595 (o3), 0.375 (o4), and 0.800 (o5) for the ischial spine sign. Interobserver reliability was 0.514 for the crossover, 0.633 for the posterior, and 0.543 for the ischial spine sign wall. The experience sum score correlated to the kappa results for the crossover (r=0.527), posterior wall (r=0.738), and ischial spine sign (r=0.949). Assessing acetabular version on plain radiographs is subject to intra- and interindividual error and related to the observer’s individual experience.