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


Recognition of total elbow arthroplasties (TEAs) on plain radiographs is difficult due to a multitude of different types and models. Especially if surgery reports and documentation are not available, lost or when the primary surgery was performed in another hospital the prosthesis type may be undeterminable. Therefore we investigated in this platform study if a flowchart aids in recognition of thirteen different total elbow arthroplasty models on plain radiographs.


An online questionnaire on the Shoulder and Elbow Platform was developed. Plain radiographs of thirteen TEA models were shown with and without the help of an especially developed flowchart describing distinguishing features.


Ten orthopedic surgeons specialized in upper extremity surgery completed the study. Recognition rates of the thirteen total elbow arthroplasty models ranged between 20 and 100 percent without the flowchart. Using the flowchart recognition 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.


Correct recognition of total elbow arthroplasty models with plain radiographs remains imperfect with our developed flowchart. The flowchart increased correct recognition rates and inter-observer reliability.

 2019 Sep;7(5):407-415.