Abstract
Background
Trapeziometacarpal, or thumb carpometacarpal (CMC), arthritis is a common problem with a variety of treatment options. Although widely used, the Eaton radiographic staging system for CMC arthritis is of questionable clinical utility, as disease severity does not predictably correlate with symptoms or treatment recommendations. A possible reason for this is that the classification itself may not be reliable, but the literature on this has not, to our knowledge, been systematically reviewed.
Questions/purposes
We therefore performed a systematic review to determine the intra- and interobserver reliability of the Eaton staging system.
Methods
We systematically reviewed English-language studies published between 1973 and 2013 to assess the degree of intra- and interobserver reliability of the Eaton classification for determining the stage of trapeziometacarpal joint arthritis and pantrapezial arthritis based on plain radiographic imaging. Search engines included: PubMed, Scopus®, and CINAHL. Four studies, which included a total of 163 patients, met our inclusion criteria and were evaluated. The level of evidence of the studies included in this analysis was determined using the Oxford Centre for Evidence Based Medicine Levels of Evidence Classification by two independent observers.
Results
A limited number of studies have been performed to assess intra- and interobserver reliability of the Eaton classification system. The four studies included were determined to be Level 3b. These studies collectively indicate that the Eaton classification demonstrates poor to fair interobserver reliability (kappa values: 0.11–0.56) and fair to moderate intraobserver reliability (kappa values: 0.54–0.657).
Conclusions
Review of the literature demonstrates that radiographs assist in the assessment of CMC joint disease, but there is not a reliable system for classification of disease severity. Currently, diagnosis and treatment of thumb CMC arthritis are based on the surgeon’s qualitative assessment combining history, physical examination, and radiographic evaluation. Inconsistent agreement using the current common radiographic classification system suggests a need for better radiographic tools to quantify disease severity.
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Acknowledgments
The authors thank the librarians at Lane Library in Stanford University School of Medicine, especially Christopher Stave, for ensuring academic rigor and thorough search strategies for this systematic review.
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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
One of the authors (ALL) certifies that she, or a member of her immediate family, has received or may receive funding, during the study period, from The Ronald and Ann Williams Foundation Charitable Trust and the NIH (Bethesda, MD, USA) (Grants 1R01AR059185-01A1 and R43 EB003067-02A1.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
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Berger, A.J., Momeni, A. & Ladd, A.L. Intra- and Interobserver Reliability of the Eaton Classification for Trapeziometacarpal Arthritis: A Systematic Review. Clin Orthop Relat Res 472, 1155–1159 (2014). https://doi.org/10.1007/s11999-013-3208-z
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DOI: https://doi.org/10.1007/s11999-013-3208-z