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Reliability of radiologic assessment following total elbow arthroplasty: a varying observer agreement
Willemijn van Dam1, Danielle Meijering1, Alexander L Boerboom1
1Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Background:
Total elbow arthroplasty (TEA) is used to treat a variety of elbow pathologies. Survival rates following TEA remain relatively low, and complications are often reported. Radiographic evaluation has been used to detect complications. However, standardized assessment for evaluation is missing, and reliability of investigating different parameters has never been investigated. Therefore, this study aimed to evaluate intra- and interobserver reliability of the most commonly used radiologic parameters following TEA.
Methods:
Anteroposterior and lateral radiographs of 29 patients who underwent Latitude TEA were evaluated for 14 parameters by 4 experienced upper limb orthopedic surgeons. Primary outcome parameter (implant positioning), parameters with direct clinical consequences (radial head disengagement, periprosthetic fractures, shift, subluxation/dislocation, implant breakage), and parameters with long-term clinical consequences (vertical cementation index, heterotopic ossification, radiolucent lines, bone resorption, center of rotation, metallosis, wear) were evaluated. Intra- and interobserver agreement was determined by intraclass correlation coefficient (ICC) for continuous and Fleiss kappa (κ) for categorical parameters. ICC >0.75 and κ >0.81 were considered reliable.
Results:
Determining implant positioning and vertical cementation index appeared reliable for both intra- and interobserver agreement. The other outcome parameters showed much variability, with agreements varying from poor to almost perfect but overall appearing insufficiently reliable.
Conclusion:
The results of this study demonstrate that implant positioning and vertical cementation index in radiographs of total elbow prostheses can be determined reliably and can be used to assess the postoperative result. The other outcome parameters, for example, radial head disengagement, periprosthetic fractures, shift, dislocation, heterotopic ossifications, radiolucencies, bone resorption, center of rotation, metallosis, and wear, appeared overall insufficiently reliable and should not yet be used until more research into the definition, measurement, and scoring of these parameters is conducted. Also, more education for detecting these parameters on radiographs is essential before a standardized assessment protocol can be created.
