Reliability of the commonly used classification systems for interprosthetic fractures
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ORIGINAL ARTICLE • HIP & KNEE - FRACT URE S
Reliability of the commonly used classification systems for interprosthetic fractures Toby Jennison1 · Abdulla Jawed1 · Ahmed ElBakoury1 · Hazem Hosny1 · Rathan Yarlagadda1 Received: 23 June 2018 / Accepted: 4 February 2019 © Springer-Verlag France SAS, part of Springer Nature 2019
Abstract Objectives An interprosthetic fracture occurs between a hip and knee arthroplasty. There is currently no universally agreed classification. The aim of this study was to determine the interobserver and intraobserver reliability of the most commonly used interprosthetic fracture classifications. Methods Nineteen interprosthetic fractures were classified by four reviewers for inter- and intraobserver reliability. The most commonly used interprosthetic fracture classifications were the Soenen classification, Platzer classification, and Pires classification. Cohen’s kappa coefficient was calculated. Results A moderate interobserver reliability was found for all the classification systems. The Platzer classification had a kappa value of 0.586, the Pires classification 0.499, and Soenen classification 0.489. The intraobserver error was 0.767 for the Platzer classification (substantial agreement), 0.636 for the Pires classification (substantial agreement), and 0.318 for the Soenen classification (fair agreement). Conclusions This study has demonstrated moderate interobserver reliability and substantial intraobserver reliability for both the Platzer and Pires classifications. This paper would recommend the use of either classification for interprosthetic fractures. Keywords Interprosthetic fracture · Platzer classification · Pires classification · Interobserver error · Intraobserver error
Introduction There are increasing numbers of lower limb arthroplasties being undertaken [1]. This increases the risk of these patients sustaining an interprosthetic fracture. These occur between a total knee replacement and a femoral stem of either a hemiarthroplasty or total hip replacement [2–4]. There is currently no universally agreed treatment algorithm or classification system for interprosthetic fractures [5, 6]. Several have been suggested. These were initially based on modifications of classifications used for periprosthetic fractures such as the Vancouver classification [5, 7, 8]. More recently, separate classifications have been proposed [9]. Despite this, there is still currently no universally accepted classification and few studies have assessed the reliability of these classifications systems [5, 6].
* Toby Jennison [email protected] 1
Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, UK
The primary aim of this study was to determine the interobserver and intraobserver reliability of the most commonly used interprosthetic fracture classifications. The secondary outcome was to determine whether these classifications could reliably guide treatment for these fractures.
Materials and methods Patients were identified from a hospital database of all
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