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

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