Clinical Orthopaedics and Related Research®

, Volume 472, Issue 4, pp 1155–1159

Intra- and Interobserver Reliability of the Eaton Classification for Trapeziometacarpal Arthritis: A Systematic Review

Symposium: Thumb Carpometacarpal Arthritis

DOI: 10.1007/s11999-013-3208-z

Cite this article as:
Berger, A.J., Momeni, A. & Ladd, A.L. Clin Orthop Relat Res (2014) 472: 1155. doi:10.1007/s11999-013-3208-z

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.

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  1. 1.Division of Plastic and Reconstructive SurgeryStanford University Medical CenterPalo AltoUSA
  2. 2.Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic SurgeryStanford University Medical CenterPalo AltoUSA