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This study examines the reliability of a novel score to classify subchondral bone health in hip arthroscopy.

May 14, 2026Journal of Hip Preservation Surgery0 citationsOpen Access

Reliability of A Novel Arthroscopic Femoral Head and Neck Subchondral Bone Health Classification: Subchondral Porosity and Resilience Score (SPRS)

HSHashim J F Shaikh BSBrent Sanderson TDTerrence Daley-Lindo

Key Points

This study examines the reliability of a novel score to classify subchondral bone health in hip arthroscopy.
Prospective study involving 58 adult patients undergoing hip arthroscopy for femoroacetabular impingement.
Grading of subchondral bone health using the subchondral porosity and resilience score by three orthopedic surgeons.
Reliability assessed through intraclass correlation coefficient and Fleiss’ kappa statistics.
Interobserver agreement was 90.8%, with an ICC of 0.92 and Fleiss’ kappa value of 0.85, indicating substantial agreement.
Each SPRS grade showed substantial to perfect agreement, especially Grade 4 with a kappa value of 1.00.
Kendall’s coefficient of concordance was 0.94, showing high agreement among raters.

Abstract

Abstract The field of hip arthroscopy has rapidly advanced, becoming a primary treatment for hip disorders like femoroacetabular impingement (FAI) and labral tears. While effective for addressing mechanical impingement, managing subchondral injuries remains challenging. The condition of subchondral bone, critical for joint stability and load distribution, is often overlooked, with no established classification system for assessing its health. This study aims to assess the interobserver and intraobserver reliability of a novel subchondral porosity and resilience score (SPRS) classification for evaluating subchondral femoral head and neck bone health. A prospective study was conducted on adult patients undergoing hip arthroscopy for FAI at a tertiary orthopedic center. A novel scale was developed to quantify SPRS observations of trabecular volume, porosity, and deformity and was employed to assess subchondral bone health after the removal of articular cartilage. Grading was performed by three fellowship-trained orthopedic surgeons based on arthroscopic images and intraoperative videos. Interobserver and intraobserver reliability were assessed using the intraclass correlation coefficient (ICC) and Fleiss’ kappa statistics. A total of 58 patients were evaluated. The overall interobserver agreement was high, with a percent agreement of 90.8% and an ICC of 0.92. Fleiss’ kappa value was 0.85, indicating substantial agreement among raters. Each individual SPRS grade showed substantial to perfect agreement, particularly Grade 4, which achieved a kappa value of 1.00. Kendall’s coefficient of concordance was 0.94, demonstrating high concordance among raters. The SPRS classification demonstrates strong interobserver and intraobserver reliability, suggesting its potential utility for assessing subchondral bone health during hip arthroscopy. A standardized grading system could enhance clinical decision-making and inform future research on the relationship between bone quality and patient outcomes.

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