Reliability and accuracy of templating humeral and ulnar components for total elbow arthroplasty

We conducted a study to examine intraobserver reliability, interobserver reliability, and accuracy of preoperative templating in approximating humeral and ulnar component sizes in total elbow arthroplasty (TEA). Twenty-two patients underwent cemented TEA with 1 of 2 commonly used implants. Four independent reviewers performed templating in 2 separate sessions spaced a minimum of 2 weeks apart. Reviewers were blinded to patient information and used appropriately magnified templates provided by the implant manufacturer. Preoperative and postoperative films were assessed for humeral and ulnar stem width and length. For both implants combined, there was substantial (κ > 0.7) intraobserver reliability for humeral width, humeral length, and ulnar length. Interobserver reliability was fair for humeral width (κ = 0.28), substantial for humeral length (κ = 0.64), and moderate for both ulnar width (κ = 0.44) and ulnar length (κ = 0.49). Preoperative templating accurately predicted exact stem size 72.7% of the time and within 1 size variation 96.9% of the time. Attending surgeons were slightly more accurate than fellows (75.5% vs 71.5%) in predicting stem sizes. Preoperative templating is moderately reliable and largely accurate in planning TEA.