Reliability testing of two classification systems for osteoarthritis and post-traumatic arthritis of the elbow

Michael H Amini; Joshua B Sykes; Stephen T Olson; Richard A Smith; Benjamin M Mauck; Frederick M Azar; Thomas W Throckmorton

doi:10.1016/j.jse.2014.10.015

Reliability testing of two classification systems for osteoarthritis and post-traumatic arthritis of the elbow

J Shoulder Elbow Surg. 2015 Mar;24(3):353-7. doi: 10.1016/j.jse.2014.10.015. Epub 2014 Dec 23.

Authors

Michael H Amini¹, Joshua B Sykes¹, Stephen T Olson¹, Richard A Smith¹, Benjamin M Mauck¹, Frederick M Azar¹, Thomas W Throckmorton²

Affiliations

¹ Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
² Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA. Electronic address: tthrockmorton@campbellclinic.com.

PMID: 25541343
DOI: 10.1016/j.jse.2014.10.015

Abstract

Hypothesis and background: The severity of elbow arthritis is one of many factors that surgeons must evaluate when considering treatment options for a given patient. Elbow surgeons have historically used the Broberg and Morrey (BM) and Hastings and Rettig (HR) classification systems to radiographically stage the severity of post-traumatic arthritis (PTA) and primary osteoarthritis (OA). We proposed to compare the intraobserver and interobserver reliability between systems for patients with either PTA or OA.

Methods: The radiographs of 45 patients were evaluated at least 2 weeks apart by 6 evaluators of different levels of training. Intraobserver and interobserver reliability were calculated by Spearman correlation coefficients with 95% confidence intervals. Agreement was considered almost perfect for coefficients >0.80 and substantial for coefficients of 0.61 to 0.80.

Results: In patients with both PTA and OA, intraobserver reliability and interobserver reliability were substantial, with no difference between classification systems. There were no significant differences in intraobserver or interobserver reliability between attending physicians and trainees for either classification system (all P > .10). The presence of fracture implants did not affect reliability in the BM system but did substantially worsen reliability in the HR system (intraobserver P = .04 and interobserver P = .001).

Conclusions: The BM and HR classifications both showed substantial intraobserver and interobserver reliability for PTA and OA. Training level differences did not affect reliability for either system. Both trainees and fellowship-trained surgeons may easily and reliably apply each classification system to the evaluation of primary elbow OA and PTA, although the HR system was less reliable in the presence of fracture implants.

Keywords: Elbow; classification; osteoarthritis; post-traumatic arthritis; reliability.

Publication types

Comparative Study

MeSH terms

Clinical Competence
Elbow Injuries*
Elbow Joint / diagnostic imaging*
Elbow Joint / surgery
Humans
Intra-Articular Fractures / complications*
Intra-Articular Fractures / diagnostic imaging
Intra-Articular Fractures / surgery
Observer Variation
Osteoarthritis / classification*
Osteoarthritis / diagnostic imaging*
Osteoarthritis / etiology
Radiography
Reproducibility of Results
Severity of Illness Index