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Updated: May 22, 2026

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

Published on: January 24, 2018

Reliability of a complication classification system for orthopaedic surgery.

Ernest L Sink¹, Michael Leunig, Ira Zaltz

¹Hospital for Special Surgery, New York, NY 10021, USA. sinke@hss.edu

Clinical Orthopaedics and Related Research

|April 25, 2012

Summary

A modified Clavien-Dindo classification for orthopaedic surgery shows high reliability in grading complications for hip preservation procedures. This standardized system improves the consistency and comparability of outcome studies in orthopaedic surgery.

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Last Updated: May 22, 2026

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Published on: January 24, 2018

Area of Science:

Orthopaedic Surgery
Surgical Complication Grading
Health Services Research

Background:

Standardized methods for grading surgical complications in orthopaedics are lacking.
Objective and concurrent complication assessment is crucial for evaluating surgical outcomes.
The Clavien-Dindo classification is a validated system used in general surgery.

Purpose of the Study:

To assess the reliability of a modified Clavien-Dindo classification for orthopaedic surgery.
Specifically, to determine the interobserver and intraobserver reliability of this adapted system in hip preservation surgery.
To evaluate if the classification demonstrates high reliability when applied to a specific orthopaedic subspecialty.

Main Methods:

Adapted the validated Clavien-Dindo complication classification system for orthopaedic surgery.
Developed 44 complication scenarios from a prospective multicenter hip preservation database and literature.
Ten hip surgeons from eight centers across three countries graded scenarios twice, with Fleiss' and Cohen's κ statistics used for reliability analysis.

Main Results:

The adapted classification demonstrated high interobserver reliability with an overall Fleiss' κ of 0.887.
Intraobserver reliability was also high, with a Cohen's κ of 0.891.
Specific grade reliabilities ranged from 0.838 to 0.925, indicating consistent grading across different levels of severity.

Conclusions:

The adapted Clavien-Dindo classification exhibits high interobserver and intraobserver reliability for grading complications in hip preservation surgery.
This grading scheme offers a potential solution for standardizing complication reporting in orthopaedics.
Implementation of this system can enhance the comparability and validity of outcome studies in orthopaedic surgery.