Orthopaedic Trainee Confidence in Elbow Arthrocentesis Using a Cadaveric Elbow Effusion Training Model.

Abstract

Elbow arthrocentesis facilitates diagnosis of infectious versus noninfectious elbow joint pathologies. Arthrocentesis is considered minimally invasive, but there is still risk for injury to surrounding structures and an associated learning curve. The purpose of this investigation was to compare orthopaedic trainee confidence and success at different levels of training while performing an elbow arthrocentesis through lateral and posterior approaches. Ten, fresh-frozen, cadaveric specimens were assigned to senior residents, junior residents, and interns. Two milliliters of ISOVUE contrast and fluoroscopic imaging was used to confirm needle placement. Twenty milliliters of blue dye was used to create a simulated effusion. Standardized instructions on performing a lateral and posterior elbow arthrocentesis were provided. Three consecutive lateral or posterior aspirations on three specimens were done and level of confidence (1 to 5) and number of attempts to successful aspiration were recorded. Data were analyzed using analysis of variance, t-tests, Kruskal-Wallis, and Mann-Whitney tests. Mean attempts to successful aspiration did not differ between seniors, juniors, and interns (1.6, 1.5, and 2.4, respectively, P = 0.068). For all trainees, posterior approach required a mean of 2.7 attempts, whereas the lateral approach required a mean of 1.3 attempts (P < 0.001). Interns were not as confident as seniors and juniors during any aspiration (P < 0.05). Juniors and seniors had equivalent confidence (P = 0.234). Finally, trainees were more confident (mean rank = 73.5) with the lateral approach compared with the posterior approach (mean rank = 47.5; P < 0.001). Procedural confidence was dependent on the level of trainee and familiarity with approach. The number of attempts leading to successful aspiration only differed with approach and did not vary with respect to the level of training or confidence. These results provide important implications to consider while teaching orthopaedic trainees at varying levels of experience.