Interobserver and Intraobserver Reliability of a new prognostic classification for foot and ankle Charcot arthropathy

Abstract

Background Recently, a new prognostic classification for foot and ankle Charcot arthropathy (Mansoura Classification) was published. The aim of this study was to evaluate both interobserver and intraobserver reliability of Mansoura classification for foot and ankle Charcot arthropathy. Methods Mansoura classification for foot and ankle Charcot arthropathy was presented to participants at an international foot and ankle course, then participants were given colored printed copy of the classification table and diagrams. Thereafter, twenty cases of foot and ankle Charcot were presented to participants and they were asked to rate each case according to the classification. Furthermore, six raters who were specialized in foot and ankle surgery were asked to repeat the classification of the cases after three weeks from the initial evaluation. Kappa statistics was used to evaluate both interobserver and intraobserver reliability using STATA 14.2 program. Results Sixty-one participants with different level of experience completed the evaluation of the twenty cases of foot and ankle Charcot. The interobserver reliability for all participants was moderate (Kappa = 0.5). Further analysis according to the level of experience based on the years of practice of orthopedic surgery showed similar moderate reliability (range, 0.4–0.57). Intraobserver reliability was excellent for all six participants (range, 0.81–0.93). Further analysis of the interobserver reliability of the former six raters who were specialized in foot and ankle surgery showed substantial reliability; Kappa = 0.67. Conclusion Mansoura classification for Charcot arthropathy of foot and ankle has an excellent intraobserver reliability. The overall interobserver reliability among orthopedic surgeons was moderate and comparable to other classifications, and the interobserver reliability for orthopedic surgeons who were specialized in foot and ankle surgery was substantial. Therefore, Mansoura classification for foot and ankle Charcot has an acceptable reliability and could be promising in the evaluation and guiding the management of such cases. LEVEL OF EVIDENCE: Level IV case series