Background: End-stage ankle arthritis should have an appropriate classification to assist surgeons in the management of end-stage ankle arthritis. Outcomes research also requires a classification system to stratify patients appropriately. Materials and Methods: Six fellowship trained foot and ankle surgeons met on two occasions to derive a classification system for end-stage ankle arthritis. A four-part classification system was designed. Four surgeons reviewed blinded patient profiles and radiographs on two occasions to determine the inter- and intraobserver reliability. Results: Good interobserver reliability (kappa = 0.62) and intraobserver reproducibility (kappa = 0.72) was demonstrated for the classification system. Conclusion: The COFAS classification system appears to be a valid tool for the management and research of end-stage ankle arthritis.
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References
1.
. BaldessariniRJFinklesteinSAranaGW: The predictive power of diagnostic tests and the effect of prevalence of illness”. Archives of General Psychiatry40:569–73, 1983.
2.
. BhattacharyaRVassanUTFinnP: Sanders classification of fractures of the os calcis. An analysis of inter- and intraobserver variability. J Bone Joint Surg Br., 87:205–8, 2005. http://dx.doi.org/10.1302/0301-620X.87B2.15260.
3.
. BernsteinJAdlerLMBlankJE: Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone and Joint Surg Am.78:1371–1375, 1996.
4.
. BrumbackRJJonesAL: Interobserver agreement in the classification of open fractures of the tibia: the results of a survey of two hundred and forty-five orthopaedic surgeons. J Bone Joint Surg Am., 75:1162–6, 1994.
5.
. BuechelFFSr. BuechelFFJr.PappasMJ: Twenty-year evaluation of cementless mobile-bearing total ankle replacements. Clin Orthop Relat Res., 424:19–26, 2004. http://dx.doi.org/10.1097/01.blo.0000132243.41419.59.
6.
. CoesterLMSaltzmanCLLeupoldJPontarelliW: Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am., 83:219–28, 2001.
. DoetsHCBrandRNelissenRG: Total ankle arthroplasty in inflammatory joint disease with use of two mobilebearing designs. J Bone Joint Surg Am., 88:1272–84, 2006. http://dx.doi.org/10.2106/JBJS.E.00414.
10.
. GarbuzDSMasriBAEsdaileJ: Classification in orthopedics. J Am Acad Orthop Surg., 10:290–7, 2002.
11.
. GlazebrookMDanielsTYoungerAS: Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. J Bone Joint Surg Am., 90:499–505, 2008. http://dx.doi.org/10.2106/JBJS.F.01299.
12.
. HaddadSLCoetzeeJCEstokR: Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. J Bone Joint Surg Am., 89:1899–1905, 2007. http://dx.doi.org/10.2106/JBJS.F.01149.
13.
. JohnsonEWBosekerEH: Arthrodesis of the ankle. Arch Surg., 97:766–73, 1968.
14.
. KrederHJHanelDPMckeeM: Consistency of AO fracture classification for the distal radius. J Bone Joint Surg Br., 78: 726–31, 1996.
15.
. LandisJRKochGG: The measurement of observer agreement for categorical data. Biometrics33:159–174, 1977. http://dx.doi.org/10.2307/2529310.
16.
. LauderAJIndaDJBottAM: Interobserver and intraobserver reliability of two classification systems for intra-articular calcaneal fractures. Foot Ankle Int., 27:251–5, 2006.
17.
. LenkeLGBetzRRBridwellKH: Spontaneous lumbar curve coronal correction after selective anterior or posterior fusion in adolescent idiopathic scoliosis. Spine, 24:1663–71, 1999. http://dx.doi.org/10.1097/00007632-199908150-00007.
18.
. LenkeLGBetzRRHarmsJ: Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am., 83:1169–81, 2001.
19.
. MalekIAMachaniBMevchaAM: Interobserver reliability and intraobserver reproducibility of the Weber classification of ankle fractures. J Bone Joint Surg Br., 88:1204–6, 2006. http://dx.doi.org/10.1302/0301-620X.88B9.17954.
20.
. MannRARongstadKM: Arthrodesis of the ankle: A critical analysis. Foot Ankle Int., 19:3–9, 1998.
21.
. RasmussenSMadsenPVBennickeK: Observer variation in the Lauge-Hansen classification of ankle fractures: Precision improved by instruction. Acta Orthop. Scand., 64:693–694, 1993.
. San GiovanniTPKeblishDJThomasWH: Eight-year results of a minimally constrained total ankle arthroplasty, Foot Ankle Int., 27:418–26, 2006.
24.
. SiebenrockKAGerberC: The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am., 75:1751–5, 1993.
25.
. SidorMLZuckermanJDLyonT: The Neer classification system for proximal humerus fractures: an assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am., 75:1745–50, 1993.
26.
. SmithSWMeyerRAConnorPM: Interobserver reliability and intraobserver reproducibility of the modified Ficat classification system of osteonecrosis of the femoral head. J Bone Joint Surg Am., 78:1702–6, 1996.
27.
. SooHooNFZigmondDSKoCY: Comparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty. J Bone Joint Surg Am., 89:2143–9, 2007. http://dx.doi.org/10.2106/JBJS.F.01611.
28.
. SwiontkowskiMFSandsAKAgelJ: Interobserver variation in the AO/OTA fracture classification system for pilon fractures: is there a problem?J Orthop Trauma, 11:467–70, 1997. http://dx.doi.org/10.1097/00005131-199710000-00002.
. ThomsenNOOvergaardSOlsenLH: Observer variation in the radiographic classification of ankle fractures. J Bone Joint Surg Br., 73:676–8, 1991.
31.
. ThomsenNOJensenCMSkovgaardNP: Observer variation in the radiographic classification of fractures of the neck of the femur using Garden's system. Int Orthop., 20:326–9, 1996. http://dx.doi.org/10.1007/s002640050087.
