Pre-operative templating in total elbow arthroplasty: not useful

Area of Science:

• Orthopedic Surgery
• Radiology
• Biomedical Engineering

Background:

• Total elbow arthroplasty (TEA) is a crucial procedure for severe elbow conditions like rheumatoid arthritis and osteoarthritis.
• Pre-operative digital templating is a proposed method to enhance surgical precision in TEA.
• The reliability and predictive accuracy of digital templating for TEA have not been established.

Purpose of the Study:

• To assess the intra- and inter-observer reliability of pre-operative digital templating for TEA.
• To determine the validity and predictive value of digital templating in selecting appropriate implant sizes for TEA.

Main Methods:

• Review of 21 pre-operative elbow radiographs (AP and lateral views) from patients who underwent TEA.
• Two independent assessors performed digital templating of implant sizes twice using digital overlays.
• Intra- and inter-observer reliability were calculated using Cohen's kappa; predictive value was determined by comparing templated sizes to actual implanted sizes.

Main Results:

• Substantial to almost perfect intra-observer reliability for humeral implants (κ=0.61-0.90) and moderate to substantial for ulnar implants (κ=0.54-0.73).
• Substantial inter-observer reliability for humeral implants (κ=0.67) and moderate for ulnar implants (κ=0.60).
• The predictive value for correctly templating implant sizes was 53% for both humeral and ulnar components.

Conclusions:

• Pre-operative digital templating demonstrates good reliability for planning implant sizes in total elbow arthroplasty.
• Despite its reliability in planning, the predictive accuracy of digital templating for determining the optimal implant size in TEA is currently low.