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Updated: Jun 16, 2026

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
Inter- and intraobserver reliability of the COFAS end-stage ankle arthritis classification system
Fabian G Krause1, Matthew Di Silvestro, Murray J Penner
1Unversity of British Columbia, Vancouver, Canada.
Background:
End-stage ankle arthritis should have an appropriate classification to assist surgeons in the management of end-stage ankle arthritis. Outcomes research also requires a classification system to stratify patients appropriately.
Materials And Methods:
Six fellowship trained foot and ankle surgeons met on two occasions to derive a classification system for end-stage ankle arthritis. A four-part classification system was designed. Four surgeons reviewed blinded patient profiles and radiographs on two occasions to determine the inter- and intraobserver reliability.
Results:
Good interobserver reliability (kappa = 0.62) and intraobserver reproducibility (kappa = 0.72) was demonstrated for the classification system.
Conclusion:
The COFAS classification system appears to be a valid tool for the management and research of end-stage ankle arthritis.
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