title: Pre-operative templating in total elbow arthroplasty: not useful.
abstract: OBJECTIVE
  Total elbow arthroplasty (TEA) is a definitive surgical procedure for treating rheumatoid arthritis and (posttraumatic) osteoarthritis of the elbow and is also useful in comminuted elbow fractures. Pre-operative digital templating may theoretically improve the surgical implantation of TEA, but reliability and predictive values of templating are unknown. The aim of this study was to determine the intra- and inter-observer reliability and the validity of pre-operative digital templating for TEA.
  
  
  METHODS
  All pre-operative plain anterior-posterior and lateral calibrated elbow radiographs from patients who underwent TEA in our center from 2008 to June 2014 were reviewed. Two independent assessors templated implant sizes using digital overlays twice. Intra- and inter-observer reliability were evaluated with Cohen's kappa. Two experienced elbow surgeons reviewed post-operative radiographs for evaluation. The predictive value of templating was the percentage of the correctly templated sizes, with the optimal implant size as the reference standard.
  
  
  RESULTS
  Twenty-one cases were included. Intra-observer reliability was substantial to almost perfect (κ = 0.61 and κ = 0.90) for humeral implants, moderate to substantial (κ = 0.54 and κ = 0.73) for ulnar implants. Inter-observer reliability was substantial (κ = 0.67) for humeral implants and moderate (κ = 0.60) for ulnar implants. The predictive value was 53 % for both implants.
  
  
  CONCLUSIONS
  Pre-operative digital templating for TEA is a reliable method to plan implant sizes. However, the predictive value is low.
authors.affiliation: Department of Orthopaedic Surgery, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands. aprkic@live.nl.
authors.forename: Ante
authors.identifier: http://orcid.org/0000-0002-2920-8564
authors.initials: A
authors.lastname: Prkić
authors.affiliation: Department of Orthopaedic Surgery, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
authors.forename: Christiaan J A
authors.initials: CJ
authors.lastname: van Bergen
authors.affiliation: Department of Orthopaedic Surgery, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
authors.forename: Bertram
authors.initials: B
authors.lastname: The
authors.affiliation: Department of Orthopaedic Surgery, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: Eygendaal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000601:surgery; D057929:Arthroplasty, Replacement, Elbow / Q000295:instrumentation* / Q000379:methods*; D004550:Elbow / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005598:Fractures, Spontaneous / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000601:surgery; D008875:Middle Aged; D015588:Observer Variation; D010003:Osteoarthritis / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D011859:Radiography; D015203:Reproducibility of Results
keywords: Reliability; Templating; Total elbow arthroplasty; Validity