How Well do Orthopedic Surgeons Recognize Different Models of Total Elbow Arthroplasties on Plain Radiographs with the Use of a Diagnostic Flowchart?

Abstract

Background: Recognition of total elbow arthroplasties (TEAs) on plain radiographs is difficult due to a multitude of<br />different types and models. Especially if surgery reports and documentation are not available, lost or when the primary<br />surgery was performed in another hospital the prosthesis type may be undeterminable. Therefore we investigated<br />in this platform study if a flowchart aids in recognition of thirteen different total elbow arthroplasty models on plain<br />radiographs.<br />Methods: An online questionnaire on the Shoulder and Elbow Platform was developed. Plain radiographs of thirteen<br />TEA models were shown with and without the help of an especially developed flowchart describing distinguishing<br />features.<br />Results: Ten orthopedic surgeons specialized in upper extremity surgery completed the study. Recognition rates of the<br />thirteen total elbow arthroplasty models ranged between 20 and 100 percent without the flowchart. Using the flowchart<br />recognition varied between 40 and 90 percent. The recognition rates with the flowchart were not significantly higher.<br />Inter-observer reliability did not increase on a significant level.<br />Conclusion: Correct recognition of total elbow arthroplasty models with plain radiographs remains imperfect with our<br />developed flowchart. The flowchart increased correct recognition rates and inter-observer reliability.<br />Level of evidence: II