Reoperations may be a better way of tracking adverse outcomes than complications. Repeat surgery causes cost to the system, and often indicate failure of the primary procedure resulting in the patient not achieving the expected improvement in pain and function. Understanding the cause of repeat surgery at the primary site may result in design improvements to implants or improvements to fusion techniques resulting in better outcomes in the future. The COFAS group have designed a reoperation classification system. The purpose of this study was to outline the inter and intra observer reliability of this classification scheme. To verify the inter- and intra-observer reliability of this new coding system, six fellow ship trained practicing foot and ankle Orthopaedic surgeons were asked to classify 62 repeat surgeries from a single surgeons practice. The six surgeons read the operation reports in random order, and reread the reports 2 weeks later in a different order. Reliability was determined using intraclass correlation coefficients (ICC) and proportions of agreement. The agreement between pairs of readings (915 for inter observer for the first and second read – 61 readings with 15 comparisons, observer 1 with observer 2, observer 1 with observer 3, etc) was determined by seeing how often each observer agreed. This was repeated for the 366 ratings for intra observer readings (61 times 6). The inter-observer reliability on the first read had a mean intra-class correlation coefficient (ICC) of 0.89. The range for the 15 comparisons was 0.81 to 1.0. Amongst all 1830 paired codings between two observers, 1605 (88%) were in agreement. Across the 61 cases, 45 (74%) were given the same code by all six observers. However, the difference when present was larger with more observers not agreeing. The inter-observer reliability test on the second read had a mean ICC of 0.94, with a range of 0.90. There were 43 (72%) observations that were the same across all six observers. Of all pairs (915 in total) there was agreement in 804 pairs for the first reading (88%) and disagreement in 111 (12%). For the second reading there was agreement in 801 pairs (86%) and disagreement in 114 (14%). The intra-observer reliability averaged an ICC value of 0.92, with a range of 0.86 to 0.98. The observers agreed with their own previous observations 324 times out of 366 paired readings (89% agreement of pairs). The COFAS classification of reoperations for end stage ankle arthritis was reliable. This scheme potentially could be applied to other areas of Orthopaedic surgery and should replace the Claiden Dindo modifications that do not accurately reflect Orthopaedic outcomes. As complications are hard to define and lack consistent terminology reoperations and resource utilisation (extra clinic visits, extra days in hospital and extra hours of surgery) may be more reliable measures of the negative effects of surgery.
The purpose of our study was to compare the performance of a new intramedullary reaming device to a contemporary reaming system. The new intramedullary reaming device was the Synthes Reamer/Irrigator/Aspirator reamer (RIA) which differs from contemporary reaming devices in that it has a built-in irrigation and aspiration system to reduce the intramedullary pressures and temperatures associated with reaming. An in-vivo cadaver model was developed to quantify intramedullary pressure, temperature, speed and force of reaming. The results showed significant differences in intramedullary pressures with no significant differences in speed and force of reaming. The purpose of our study was to compare the performance of a new intramedullary reaming device to a contemporary reaming system. The Synthes Reamer/Irrigator/Aspirator reamer (RIA) produced significantly lower peak and average intramedullary pressures during reaming with no significant differences in speed and force of reaming. A reaming system with a built-in irrigation/aspiration could possibly reduce the morbidity and mortality associated with the reaming of long bone fractures. There were significantly lower minimum, maximum and average proximal and distal intramedullary pressures with the RIA reamer. There were no significant differences in force or speed of reaming. No temperature changes were noted with either reaming system. A cadaveric model was developed to compare the RIA reaming system to a contemporary reaming system. Pressures were measured with pressure transducers inserted proximally and distally. Temperatures were measured with thermocouples inserted adjacent to isthmus. Force of reaming was measured with a load cell distally. Speed was calculated from data collected from a linear voltage displacement transducer. Fifteen, matched pairs of frozen, unpreserved femurs were reamed using both reaming systems and the data collected. Canals were reamed to a diameter two centimeters greater than the templated canal size. Data was collected and analyzed with paired t-tests (p<
.05). Embolic material within the cardiovascular system has been shown to increase morbidity and mortality in susceptible individuals. Embolization is related to increased intramedullary pressures. The RIA reamer, as a result of its built-in irrigation/aspiration capacity, produces lower intramedullary pressures. This may have clinical significance.
