Reliability of radiologic assessment following total elbow arthroplasty: a varying observer agreement

Willemijn van Dam ¹, Danielle Meijering ¹, Alexander L Boerboom ¹

⁰Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

Journal of Shoulder and Elbow Surgery +

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January 31, 2025

View abstract on PubMed

Summary

Radiographic assessment of total elbow arthroplasty (TEA) shows that implant positioning and vertical cementation index are reliable indicators. However, other parameters for evaluating complications after TEA lack sufficient reliability for clinical use.

Area Of Science

Orthopedic surgery
Radiology
Biomedical engineering

Background

Total elbow arthroplasty (TEA) is a treatment for various elbow pathologies, but it has low survival rates and frequent complications.
Radiographic evaluation is used to detect complications, yet lacks standardized assessment and reliability data for its parameters.
This study addresses the need to evaluate the reliability of commonly used radiologic parameters following TEA.

Purpose Of The Study

To assess the intra- and interobserver reliability of 14 commonly used radiologic parameters in patients who underwent Latitude Total Elbow Arthroplasty (TEA).
To determine which radiologic parameters are reliable for assessing postoperative results and complications after TEA.

Main Methods

Four orthopedic surgeons evaluated 14 parameters on anteroposterior and lateral radiographs of 29 Latitude TEA patients.
Parameters included implant positioning, clinical consequences (e.g., fractures, dislocation), and long-term consequences (e.g., heterotopic ossification, wear).
Intraclass correlation coefficient (ICC) and Fleiss kappa (κ) were used to determine intra- and interobserver agreement.

Main Results

Determining implant positioning and vertical cementation index demonstrated reliable intra- and interobserver agreement.
Most other evaluated parameters, including those with direct or long-term clinical consequences, showed significant variability and were deemed insufficiently reliable.
Agreements for other parameters ranged from poor to almost perfect but were not consistently reliable.

Conclusions

Implant positioning and vertical cementation index are reliable radiologic parameters for assessing postoperative results after TEA.
Many other commonly assessed parameters (e.g., heterotopic ossification, radiolucencies, wear) are currently insufficiently reliable for clinical use.
Further research is needed to define, measure, and score these less reliable parameters, alongside education, to develop a standardized assessment protocol for TEA radiographs.

Keywords:

Implant positioning elbow prosthesis observer agreement radiographs reliability total elbow arthroplasty