Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Shaarani SR, McHugh G, Collins DA. Accuracy of digital preoperative templating in 100 consecutive uncemented total hip arthroplasties: a single surgeon series. J Arthroplasty 2013;28:331-7. [PMID: 22854351 DOI: 10.1016/j.arth.2012.06.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/11/2012] [Indexed: 02/01/2023] Open

For:	Shaarani SR, McHugh G, Collins DA. Accuracy of digital preoperative templating in 100 consecutive uncemented total hip arthroplasties: a single surgeon series. J Arthroplasty 2013;28:331-7. [PMID: 22854351 DOI: 10.1016/j.arth.2012.06.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/11/2012] [Indexed: 02/01/2023] Open

Number

Cited by Other Article(s)

Kilkenny CJ, O'Driscoll C, Jassim S, Davey MS, McGoldrick NP, Quinlan JF. Preoperative Templating Prior to Total Hip Arthroplasty: A Closed-Loop Audit. Cureus 2025;17:e77083. [PMID: 39917097 PMCID: PMC11801496 DOI: 10.7759/cureus.77083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2025] [Indexed: 02/09/2025] Open

Abstract

BACKGROUND

Preoperative templating is an essential process in total hip arthroplasty (THA), aiding surgical planning and implant selection to optimize patient outcomes. Despite its significance, templating is inconsistently practiced, influenced by factors such as surgeon experience and institutional protocols. In light of increasing THA rates, this study aimed to assess adherence to templating guidelines within our institution and evaluate the impact of a new protocol on compliance.

METHODS

We conducted a closed-loop audit with an initial review of 50 THA cases, assessing the frequency and timing of preoperative templating. Following the first audit cycle, a departmental protocol was introduced, mandating templating radiographs 7-180 days before surgery, supported by a departmental rota. In the subsequent audit cycle, another 50 patients were reviewed. Templating was performed using TraumaCad software (Orthocrat Ltd, Petach Tikva, Israel) on anteroposterior pelvic radiographs with a calibration sphere. Statistical analysis was conducted using Welch's unpaired t-test. Leg length changes were evaluated in all patients based on their two most recent radiographs during the second audit cycle to determine if leg lengths had changed over time.

RESULTS

In the pre-intervention cycle, only 20% of patients had templating radiographs within the recommended timeframe, with an average of 140 days between the most recent radiograph and surgery. Post-intervention, compliance improved significantly, with 70% of patients receiving templating radiographs within the specified period (p < 0.0001), and the average time between the most recent radiograph and surgery reduced to 33 days. A mean leg length change of 2.26 mm was observed, with changes ranging from 0 to 17 mm between radiographs. The mean interval between radiographs was 386 days.

CONCLUSION

This closed-loop audit found that implementing booking preoperative templating radiographs prior to THA and integrating them as part of the preoperative assessment process had a significant impact on the number of patients having appropriate imaging performed preoperatively. Simple interventions, such as the introduction of a roster, helped ensure compliance in the booking of departmental radiographs. This study has shown how patient parameters can change over time and emphasizes the importance of ensuring up-to-date imaging to allow accurate surgical planning.

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Parisi FR, Zampogna B, Zampoli A, Ferrini A, Albimonti G, Del Monaco A, Za P, Papalia GF, Papalia R. Planning Accuracy and Stem Offset Assessment in Digital Two-Dimensional Versus Three-Dimensional Planning in Cementless Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Clin Med 2024;13:6566. [PMID: 39518705 PMCID: PMC11546058 DOI: 10.3390/jcm13216566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 10/25/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024] Open

Abstract

Background/Objectives: Total hip arthroplasty (THA) planning is crucial for restoring hip function and minimizing complications. The present systematic review and meta-analysis aimed to assess and compare the accuracy of 2D versus 3D preoperative planning in THA. Methods: The inclusion criteria were randomized controlled trials (RCTs) and observational studies (ROSs) published in English comparing the accuracy of 2D and 3D preoperative planning for total hip arthroplasty. We excluded review articles, registers, studies not written in English, studies that did not report the cup sizing accuracy or stem sizing accuracy or give a description of the preoperative planning method used, and non-comparative studies. In June 2024, following the PRISMA 2020 statement, a systematic review and a meta-analysis of the literature were conducted in PubMed, Scopus, and the Cochrane Library. The statistical analysis software Review Manager (RevMan) version 5.4 was used to perform the meta-analysis to compare the accuracy of 2D and 3D planning, and to assess the risk of bias, the ROBINS-I tool was used. Results: The analysis included 777 patients from six studies. The analysis showed that 3D planning offers superior precision compared to 2D planning, both for the cup (96.92% vs. 87.14%) and the stem (94.72% vs. 86.28%). The forest plots assessed a better trend for 3D planning in terms of exact size prediction and accuracy within ±1 size. Conclusions: The three-dimensional method was more precise and accurate than two-dimensional planning, both for the stem and the cup. It offered a detailed three-dimensional view of the patient's anatomy. The main limitation was the challenge in finding homogeneous data regarding biomechanical parameters, surgical approaches, and different planning systems for both three-dimensional and two-dimensional methods.

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Affiliation(s)

Francesco Rosario Parisi Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (F.R.P.); (B.Z.); (A.Z.); (A.F.); (G.A.); (A.D.M.); (P.Z.); (R.P.) Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Biagio Zampogna Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (F.R.P.); (B.Z.); (A.Z.); (A.F.); (G.A.); (A.D.M.); (P.Z.); (R.P.) Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy BIOMORF Department of Biomedical, Dental, Morphological and Functional Images, University of Messina. A.O.U. Policlinico “G.Martino”, Via Consolare Valeria, 98124 Messina, Italy
Andrea Zampoli Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (F.R.P.); (B.Z.); (A.Z.); (A.F.); (G.A.); (A.D.M.); (P.Z.); (R.P.) Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Augusto Ferrini Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (F.R.P.); (B.Z.); (A.Z.); (A.F.); (G.A.); (A.D.M.); (P.Z.); (R.P.) Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Giorgio Albimonti Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (F.R.P.); (B.Z.); (A.Z.); (A.F.); (G.A.); (A.D.M.); (P.Z.); (R.P.) Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Alessandro Del Monaco Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (F.R.P.); (B.Z.); (A.Z.); (A.F.); (G.A.); (A.D.M.); (P.Z.); (R.P.) Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Pierangelo Za Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (F.R.P.); (B.Z.); (A.Z.); (A.F.); (G.A.); (A.D.M.); (P.Z.); (R.P.) Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Giuseppe Francesco Papalia Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (F.R.P.); (B.Z.); (A.Z.); (A.F.); (G.A.); (A.D.M.); (P.Z.); (R.P.) Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Rocco Papalia Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (F.R.P.); (B.Z.); (A.Z.); (A.F.); (G.A.); (A.D.M.); (P.Z.); (R.P.) Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy

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Wu J, Lin C, Zhuang X, He L, Wang J, Zhou X, Xu N, Xie H, Lv H, Ye H, Zhang R. How does the position of the pelvis and femur influence the selection of prosthesis size during 2D preoperative planning for total hip arthroplasty? BMC Musculoskelet Disord 2024;25:845. [PMID: 39448960 PMCID: PMC11515560 DOI: 10.1186/s12891-024-07955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/14/2024] [Indexed: 10/26/2024] Open

Abstract

PURPOSE

Total Hip Arthroplasty (THA) is the primary treatment for hip diseases today. Nevertheless, total hip arthroplasty has its challenges, and one of these challenges is the potential for incorrect execution of the preoperative planning process. Such errors can lead to complications such as loosening and instability of the prosthesis and leg length discrepancy. In this study, we used human phantoms to investigate the influence of pelvic and femoral factors on prosthesis size selection in the preoperative planning of total hip arthroplasty and to provide a reference standard for clinical imaging in preoperative planning of total hip arthroplasty.

METHODS

In this experiment, we utilised a custom-made experimental device that enabled us to manipulate the movement of the pelvis and femur in various directions. The device also incorporated sensors to control the angle of movement. By obtaining X-rays from different positions and angles, we were able to determine the size of the prosthesis based on the 2D preoperative planning generated by the mediCAD software.

RESULTS

When the pelvis was in a nonneutral position, the size of the acetabular cup varied within a range of three sizes. Similarly, when the femur was in a nonneutral position, the size of the femoral stem varied within a range of two sizes. The movement of the pelvis and femur in the coronal plane, relative to the neutral position, did not impact the selection of the prosthesis size. However, the motion of the pelvis and femur in the sagittal and transverse planes had a notable effect.

CONCLUSION

The selection of the prosthesis size for preoperative planning can be significantly influenced by specific positions of the pelvis and femur. It is crucial for the radiographer to ensure that the pelvis and femur maintain a standard neutral position, particularly in the sagittal and transverse planes, during the image acquisition process.

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Heliere G, David G, Cypel S, Steiger V, Ducellier F, Rony L. Does two dimensional templating allow for the use of reduced-size ancillaries in total hip arthroplasty? INTERNATIONAL ORTHOPAEDICS 2024;48:2553-2559. [PMID: 39172270 PMCID: PMC11422433 DOI: 10.1007/s00264-024-06276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024]

Bouché PA, Corsia S, Auberger G, Descamps J, Anract P, Hamadouche M. Validation of mediCAD® software for fully digital preoperative planning of total hip arthroplasty: a retrospective study. Orthop Traumatol Surg Res 2024;110:103941. [PMID: 39043497 DOI: 10.1016/j.otsr.2024.103941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 07/25/2024]

Abstract

INTRODUCTION

The planning step that precedes a total hip arthroplasty (THA) procedure is crucial. Digital planning software programs are being increasingly used, although few studies have reported on the reliability of such tools. Furthermore, no studies have been conducted on the mediCAD® software, despite it being widely used in France. This led us to conduct a retrospective study to: (1) assess the accuracy of this planning software, (2) determine the intra- and inter-rater reliability, (3) determine how obesity affects the accuracy of planning.

HYPOTHESIS

THA planning is accurate and reliable when using the mediCAD® software.

PATIENTS AND METHODS

This was a single center, retrospective study. One hundred one consecutive cases performed by a single experienced surgeon were planned retrospectively by two blinded surgeons on two separate occasions. The acetabular cup was cemented in 90 hips (89%), cementless in 11 hips (11%). A dual mobility cup was used in 21 hips (21%). The femoral stem was cemented in 60 hips (59%). The endpoint was the number of exact plans, defined as the same size as the actual implants. An acceptable match was defined as a difference of one size. The match was unacceptable if the planned and implanted size differed by more than 2 for the acetabular cup or by more than 1 size for the femoral stem. The intra-rater and inter-rater reliability were calculated using the intraclass correlation coefficient (ICC) with 95% confidence intervals (CI).

RESULTS

Exact agreement was found by the first rater for 15 planned acetabular cups (15%) and for 45 planned femoral stems (45%) relative to the implants used. The second rater reached exact agreement for 20 planned acetabular cups (20%) and 50 planned femoral stems (50%). The intra-rater reliability for the acetabular cup was average (ICC = 0.57; 95%CI [0.43-0.69]) and poor (ICC = 0.38 95%CI [0.20-054]) for the 1st and 2nd rater, respectively. The intra-rater reliability for the femoral stem was poor for the 1st rater (ICC = 0.47 95%CI [0.30-0.61]) and the 2nd rater (ICC = 0.45 95%CI [0.29-0.60]). The interobserver reliability was low for the planned acetabular cup (ICC = 0.39 95%CI [0.21-0.54]) and the planned femoral stem (ICC = 0.42 95%CI [0.24-0.57]). Overall, when combining the two raters, exact prediction of the acetabular cup was achieved in 31 hips (19%) in non-obese patients and in 7 hips (21%) in obese patients (p = 0.62).

DISCUSSION

This study found acceptable reliability of the mediCAD® software. Experience level, radiograph magnification affected the planning outcome in this study, but obesity did not. We currently do not have the ability to incorporate a reliable radiological scale for two-dimensional templating. Some surgeons prefer using a CT scan, but this costs more than conventional radiographs and exposes the patient to more radiation. This study shows that the mediCAD® software can provide satisfactory output for the preoperative planning of THA.

LEVEL OF EVIDENCE

III; retrospective, diagnostic, comparative study.

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Zampogna B, Parisi FR, Zampoli A, Prezioso A, Vorini F, Laudisio A, Papalia M, Papapietro N, Falez F, Papalia R. Accuracy of two-dimensional digital planning in uncemented primary hip arthroplasty: monocentric analysis of eight hundred implants. INTERNATIONAL ORTHOPAEDICS 2024;48:1979-1985. [PMID: 38622366 DOI: 10.1007/s00264-024-06172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024]

Abstract

PURPOSE

In the last decades, there has been a refinement in total hip arthroplasty, which allowed surgeons to achieve the highest performance and better patient outcomes. Preoperative planning in primary hip arthroplasty is an essential step that guides the surgeon in restoring the anatomy and biomechanics of the joint. This study aims to evaluate the accuracy of the 2D digital planning, considering cup sizing, stem sizing, and limb length discrepancy. Additionally, we conducted a multivariable analysis of demographic data and comorbidities to find factors influencing preoperative planning.

METHODS

This retrospective study analyzed the planning accuracy in 800 consecutive uncemented primary total hip arthroplasty. We compared the preoperatively planned total hip arthroplasty with postoperative results regarding the planned component size, the implanted size, and the lower limb length restoration. Therefore, we investigated factors influencing planning accuracy: overweight and obesity, sex, age, past medical history, comorbidities, and implant design. All the surgeries were performed in the posterolateral approach by one expert surgeon who did the preoperative planning. The preoperative planning was determined to be (a) exact if the planned and the implanted components were the same size and (b) accurate if exact ± one size. The restoration of postoperative limb length discrepancy was classified into three groups: ± 3 mm, ± 5 mm, and ± 10 mm. This assessment was performed through a digital method 2D based on a standard hip X-ray.

RESULTS

This court of 800 implants showed that planning was exact in 60% of the cups and 44% of the stems and was accurate in 94% of the cups and 80% of the stems. The postoperative limb length discrepancy was ± 3 mm in 91% and ± 5 mm in 97%.

CONCLUSIONS

This study showed preoperative 2D digital planning great precision and reliability, and we demonstrated that it was accurate in 94% of the cups and 80% of the stems. Therefore, the preoperative limb length discrepancy analysis was essential to guarantee the recovery of the operated limb's correct length.

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Affiliation(s)

Biagio Zampogna Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy BIOMORF Department, Biomedical, Dental and Morphological and Functional Images, University of Messina. A.O.U. Policlinico "G.Martino", Messina, Italy
Francesco Rosario Parisi Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Andrea Zampoli Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Anna Prezioso Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Ferruccio Vorini Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Alice Laudisio Department of Medicine, Research Unit of Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy. Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Geriatrics, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
Matteo Papalia Orthopaedic and Traumatology Department, Nuova Itor Clinic, Rome, Italy
Nicola Papapietro Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Francesco Falez Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital, Rome, Italy
Rocco Papalia Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy

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Karampinas P, Vlamis J, Galanis A, Vavourakis M, Krexi A, Sakellariou E, Patilas C, Pneumaticos S. Technical note for intraoperative determination of proper acetabular cup size in primary total hip arthroplasty. World J Methodol 2024;14:90930. [PMID: 38577201 PMCID: PMC10989413 DOI: 10.5662/wjm.v14.i1.90930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/12/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open

Abstract

BACKGROUND

Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty. Implanting the accurate size of the acetabular component can occasionally be exacting, chiefly for surgeons with little experience, whilst the complications of imprecise acetabular sizing or over-reaming can be potentially devastating.

AIM

To assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved, specifically when surgeons are inexperienced or preoperative templating is unavailable.

METHODS

This method was employed in 263 operations in our department from June 2021 to December 2022. All operations were performed by the same team of joint reconstruction surgeons, employing a typical posterior hip approach technique. The types of acetabular shells implanted were: The Dynasty® acetabular cup system (MicroPort Orthopedics, Shanghai, China) and the R3® acetabular system (Smith & Nephew, Watford, United Kingdom), which both feature cementless press-fit design.

RESULTS

The mean value of all cases was calculated and collated with each other. We distinguished as oversized an implanted acetabular shell when its size was > 2 mm larger than the size of the acetabular size indicator reamer (ASIR) or when the implanted shell was larger than 4 mm compared to the preoperative planned cup. The median size of the implanted acetabular shell was 52 (48-54) mm, while the median size of the preoperatively planned cup was 50 (48-56) mm, and the median size of the ASIR was 52 (50-54) mm. The correlation coefficient between ASIR size and implanted acetabular component size exhibited a high positive correlation with r = 0.719 (P < 0.001). Contrariwise, intraoperative ASIR measurements precisely predicted the implanted cups' size or differed by only one size (2 mm) in 245 cases.

CONCLUSION

In our study, we demonstrated that the size of the first acetabular reamer not entering freely in the acetabular rim corroborates the final acetabular component size to implant. This was also corresponding in the majority of the cases with conventional preoperative templating. It can be featured as a valid tool for avoiding the potentially pernicious complications of acetabular cup over-reaming and over-sizing in primary total hip arthroplasty. It is a simple and reproducible technical note useful for confirming the predicted acetabular cup size preoperatively; thus, its application could be considered routinely, even in cases where preoperative templating is unavailable.

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Crutcher JP, Hameed D, Dubin J, Mont MA, Mont M. Comparison of three-versus two-dimensional pre-operative planning for total hip arthroplasty. J Orthop 2024;47:100-105. [PMID: 38046454 PMCID: PMC10686848 DOI: 10.1016/j.jor.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open

Abstract

Background

A successful clinical outcome for total hip arthroplasty (THA) depends on accurate sizing and positioning of the implants. Using three-dimensional (3-D) pre-operative planning with a computerized tomography (CT) scan has many potential advantages over conventional 2-D planning using radiographs, including potentially more accurate assessments of the size and anteversion of the acetabulum, as well as lateral femoral offset. The purpose of this study was to compare the accuracy of 3-D to 2-D templating with respect to acetabular and femoral size, as well as lateral femoral offset.

Methods

Pre-operative templating data was collected prospectively from a consecutive series of 290 primary THAs (acetabulum on all, femoral component on 255 of the cases using one specific stem). All cases were initially templated on a digital imaging picture archiving and communication (PACS) system with calibrated images to estimate the acetabular size, femoral size, and lateral femoral offset. The 3-D templating was then performed with software based on a CT scan, and the results were compared to what was surgically implanted.

Results

The 3-D templating for the acetabulum was accurate 99.7% of the time based on the final implanted component. The 2-D templating for the acetabulum was accurate 39% of the time, with 46% of cases templating smaller and 15% templating larger. The 3-D templating of the femoral component was accurate 63% of the time, and within one size of final implant in 96% of cases. The 2-D templating of the femoral component was accurate 53% of the time and within one size of final implant in 94% of cases. The 2-D templated femoral offset was accurate 87% of the time and was changed in 13% of cases after 3-D templating.

Conclusion

The CT-based 3-D preoperative planning was superior to 2-D planning for THA with respect to acetabular size, femoral size, and lateral femoral offset. Precise acetabular component sizing conserves bone and allows for a more predictable press fit, while facilitating efficient inventory management. Lateral femoral offset is often difficult to measure on 2-D images, and 3-D templating consistently allows for accurate offset restoration, which is important for normal hip function and stability.

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Aubert T, Galanzino G, Gerard P, Le Strat V, Rigoulot G, Lhotellier L. Accuracy of Preoperative 3D vs 2D Digital Templating for Cementless Total Hip Arthroplasty Using a Direct Anterior Approach. Arthroplast Today 2023;24:101260. [PMID: 38023640 PMCID: PMC10652126 DOI: 10.1016/j.artd.2023.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open

Kim HS, Cho SH, Moon DH, Kim CH. Risk factors for templating mismatch of uncemented stems in bipolar hemiarthroplasty for femoral neck fracture. Sci Rep 2023;13:21083. [PMID: 38030671 PMCID: PMC10687254 DOI: 10.1038/s41598-023-48538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open

Jouflas AC, Gilani SF, Nadar AC, Whitaker J, Carlson JB. Free Hip Arthroplasty Templating Software - Does it Work? Arthroplast Today 2023;23:101182. [PMID: 37712074 PMCID: PMC10498402 DOI: 10.1016/j.artd.2023.101182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 09/16/2023] Open

Abstract

Background

Preoperative planning is important for successful total hip arthroplasty (THA) and has been historically performed using acetate templates. Digital software templating has been adopted for evaluating implant size, position, and alignment. Commercial software can be expensive, but free programs exist. Detroit Bone Setter (detroitbonesetter.com, Detroit, MI) is a freely available templating program, but hasn't been validated. Our study reports this program's accuracy for templating THA.

Methods

Sixty-five patients undergoing THA between 2017 and 2022 at 2 hospitals were included. All cases were templated by the senior author or orthopaedic trauma fellow prospectively or retrospectively in a blinded fashion. Direct anterior or posterior approaches were used based on attending surgeon's preference. A student's t-test was used to compare means of templated vs actual implant sizes of femoral and acetabular components.

Results

There was no significant difference between implanted (mean [M] = 6.4, standard deviation [SD] = 2.0) and templated femoral component sizes (M = 5.7, SD = 2.1). There was a significant difference between implanted (M = 57.0, SD = 3.9) and templated acetabular component sizes (M = 53.4, SD = 3.0). Bland-Altman testing demonstrated femoral components with positive measurement bias of 0.62, indicating slight overestimation of implant size. Acetabular component size was overestimated with positive measurement bias of 3.6 mm.

Conclusions

Detroit Bone Setter is advantageous as it is freely available and supports most major company implants. It accurately templated femoral component size but consistently overestimated acetabular component size by 3.6 mm. Further studies are needed prior to recommending its routine use for templating THA when other validated methods exist. It could be used with caution when no other methods are available.

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Pongkunakorn A, Udomluck P, Aksornthung C, Wangjiraphan N. Digital Templating of THA Using PACS and an iPhone or iPad is as Accurate as Commercial Digital Templating Software. Clin Orthop Relat Res 2023;481:1104-1113. [PMID: 36730564 PMCID: PMC10194723 DOI: 10.1097/corr.0000000000002474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/07/2022] [Indexed: 02/04/2023]

Abstract

BACKGROUND

Digital templating is a standard preoperative planning method in THA. Unfortunately, many hospitals cannot afford the software or have accessibility barriers owing to a limited number of installed computer workstations. We created a templating method using a picture archiving and communication system and the Keynote program on a mobile phone. The method's accuracy and reliability have not been compared with those of commercial digital templating software.

QUESTIONS/PURPOSES

(1) How accurate is this novel method on iPhone and iPad mobile devices compared with a commercially available digital templating software program? (2) Is the method reproducible among users with different levels of experience? (3) Are the results similar for different types of femoral prostheses?

METHODS

Between January 2017 and May 2020, we treated 209 patients for hip disease or trauma with primary cementless THA. We considered patients with a normal contralateral hip as potentially eligible for this retrospective study. Thus, 91% (191 of 209 hips) were eligible; a further 13% (27 hips) were excluded because of postoperative leg length discrepancy > 5 mm, femoral offset discrepancy > 5 mm (9% [18 hips]), intraoperative periprosthetic fracture (4% [eight hips]), and proximal femoral deformity (0.5% [one hip]), leaving 78% (164 hips) for analysis here. Their preoperative radiographs were evaluated by three independent assessors, including one senior orthopaedic surgeon, one senior resident, and one junior resident, using three methods. The first was digital templating using OrthoView software, which is a commercially available digital templating software program used worldwide and known to possess high accuracy. The other two methods were technically similar to one another, with the only difference being the interface: iPhone versus iPad. In both of those approaches, using the picture archiving and communication system measurement tool, we drew a circle on an acetabular radiograph to depict the cup. We took a photograph of the computer display and imported the photograph into slides of the Keynote program, a presentation software application for Mac computers, on both devices. It was then underlaid on transparent digital templates of the femoral stem, which were scanned from plastic templates and positioned at the center of each slide. We scaled the image to the template by adjusting the image size until a 15-cm straight line on the hip photograph was equal to the 15-cm scale markers of the template. All templating results were compared with the actual implanted cementless THA components to assess accuracy. All assessors were blinded to the information about the actual implants, and they were not involved in performing the surgical procedures. The intrarater and interrater reliabilities were analyzed using intraclass correlation coefficients and kappa values. The accuracy for predicting stem size for each type of the four stem designs was compared among the three methods.

RESULTS

We were able to predict the acetabular cup size within one size in 92% of hips (151 of 164) using OrthoView and in 92% (150 of 164) using the novel method (p > 0.99). The accuracies of the three methods were comparable for predicting a femoral stem size within one size (OrthoView: 90% [148 hips], iPhone: 93% [152 hips], and iPad: 91% [149 hips]; p = 0.78), and neck length (OrthoView: 96% [157 hips], iPhone: 96% [158 hips], and iPad: 97% [159 hips]; p = 0.95). Using OrthoView, the neck offset was correctly predicted in 80% (132 hips), compared to 85% (139 hips) when using the iPhone and 82% (134 hips) when using the iPad (p = 0.57). All methods showed substantial or excellent agreement regarding intrarater and interrater reliability. There was no difference in accuracy regarding any of the four femoral stem designs we evaluated (Avenir, Excia, ML taper, and Metha).

CONCLUSION

The digital templating technique for THA using an iPhone or iPad combined with a picture archiving and communication system demonstrated high accuracy, comparable to that of commercial digital templating software. This technique is reliable and reproducible for predicting a cementless prosthesis size, neck length, and offset in different types of femoral stems. It may be useful as an alternative in resource-constrained centers where commercial software programs are too expensive to be used in practice.

LEVEL OF EVIDENCE

Level IV, diagnostic study.

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Adamczyk A, Laboudie P, Nessek H, Kim PR, Gofton WT, Feibel R, Grammatopoulos G. Accuracy of digital templating in uncemented primary total hip arthroplasty: which factors are associated with accuracy of preoperative planning? Hip Int 2023;33:434-441. [PMID: 35438031 DOI: 10.1177/11207000221082026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]

Winter P, Fritsch E, König J, Wolf M, Landgraeber S, Orth P. Comparison of the Accuracy of 2D and 3D Templating for Revision Total Hip Replacement. J Pers Med 2023;13:jpm13030510. [PMID: 36983692 PMCID: PMC10053842 DOI: 10.3390/jpm13030510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open

Schapira B, Madanipour S, Iranpour F, Subramanian P. Accuracy of Total Hip Arthroplasty Templating Using Set Calibration Magnifications. Cureus 2023;15:e34883. [PMID: 36925986 PMCID: PMC10011871 DOI: 10.7759/cureus.34883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open

The Adherence of Digital Templating of Cemented Bicondylar Total Knee Arthroplasty Reveals Gender Differences. J Clin Med 2023;12:jcm12031079. [PMID: 36769727 PMCID: PMC9917635 DOI: 10.3390/jcm12031079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open

Abstract

INTRODUCTION

Preoperative digital templating is a standard procedure that should help the operating surgeon to perform an accurate intraoperative procedure. To date, a detailed view considering gender differences in templating total knee arthroplasty (TKA), stage of arthrosis, and the surgeons' experience altogether has not been conducted.

METHODS

A series of 521 patients who underwent bicondylar total knee arthroplasty was analyzed retrospectively for the planning adherence of digital templating in relation to sex, surgeon experience, and stage of arthrosis. Pre- and postoperative X-rays were comparably investigated for planned and implanted total knee arthroplasties. Digital templating was carried out through mediCAD version 6.5.06 (Hectec GmbH, 84032 Altdorf, Germany). For statistical analyses, IBM SPSS version 28 (IBM, 10504 Armonk, NY, US) was used.

RESULTS

The general planning adherence was 46.3% for the femur and 41.8% for the tibia. The Mann-Whitney U test revealed a gender difference for templating the femur (z = -5.486; p ≤ 0.001) and tibia (z = -3.139; p = 0.002). The surgeon's experience did not show a significant difference through the Kruskal-Wallis test in the femur (K-W H = 4.123; p = 0.127) and the tibia (K-W H = 2.455; p = 0.293). The stage of arthrosis only revealed a significant difference in the planning of the femur (K-L-score (K-W H = 6.516; p = 0.038) alone.

DISCUSSION/CONCLUSION

Digital templating for total knee arthroplasty brought up gender differences, with oversized implants for women and undersized implants for men. A high stage of femoral arthrosis can lead to the under and oversized planning of the surgeon. Since the surgeon's experience in planning did not show an effect on the adherence to templating, the beneficial effect of digital templating before surgery should be discussed.

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Braun S, Brenneis M, Holder J, Meurer A, Stief F. Intra- and interobserver reliability analysis of pediatric lower limb parameters on digital long leg radiographs. J Orthop Surg Res 2023;18:69. [PMID: 36707864 PMCID: PMC9881281 DOI: 10.1186/s13018-023-03552-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open

Abstract

BACKGROUND

Malalignments of the lower extremity are common reasons for orthopedic consultation because it may lead to osteoarthritis in adulthood. An accurate and reliable radiological assessment of lower limb alignment in children and adolescents is essential for clinical decision-making on treatment of limb deformities and for regular control after a surgical intervention.

OBJECTIVE

First, does the analysis of full-length standing anteroposterior radiographs show a good intra- and interobserver reliability? Second, which parameter is most susceptible to observer-dependent errors? Third, what is the Standard Error of Measurement (SEM_95%) of the absolute femoral and tibial length?

METHODS

Two observers evaluated digital radiographs of 144 legs from 36 children and adolescents with pathological valgus alignment before a temporary hemiepiphysiodesis and before implant removal. Parameters included Mechanical Femorotibial Angle (MFA), Mechanical Axis Deviation (MAD), mechanical Lateral Distal Femoral Angle (mLDFA), mechanical Medial Proximal Tibial Angle (mMPTA), mechanical Lateral Proximal Femoral Angle (mLPFA), mechanical Lateral Distal Tibial Angle (mLDTA), Joint Line Convergence Angle (JLCA), femur length, tibial length. Intra- and interobserver reliability (ICC_2,1), SEM_95% and proportional errors were calculated.

RESULTS

The intra- and interobserver reliability for almost all measurements was found to be good to excellent (Intra-ICC_2,1: 0.849-0.999; Inter-ICC_2,1: 0.864-0.996). The SEM_95% of both observers was found to be ± 1.39° (MFA), ± 3.31 mm (MAD), ± 1.06° (mLDFA) and ± 1.29° (mMPTA). The proportional error of MAD and MFA is comparable (47.29% vs. 46.33%). The relevant knee joint surface angles show a lower proportional error for mLDFA (42.40%) than for mMPTA (51.60%). JLCA has a proportional error of 138%. Furthermore, the SEM_95% for the absolute values of the femoral and tibial length was 4.53 mm for the femur and 3.12 mm for the tibia.

CONCLUSIONS

In conclusion, a precise malalignment measurement and the knowledge about SEM_95% of the respective parameters are crucial for correct surgical or nonsurgical treatment. The susceptibility to error must be considered when interpreting malalignment analysis and must be considered when planning a surgical intervention. The results of the present study elucidate that MAD and MFA are equally susceptible to observer-dependent errors. This study shows good to excellent intra- and interobserver ICCs for all leg alignment parameters and joint surface angles, except for JLCA.

TRIAL REGISTRATION

This study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053.

LEVEL OF EVIDENCE

I, Diagnostic Study.

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More than a feeling?-Overruling the preoperatively templated offset option leads to a minor offset increase in short stem total hip arthroplasty. Arch Orthop Trauma Surg 2023;143:519-527. [PMID: 34997306 PMCID: PMC9886579 DOI: 10.1007/s00402-021-04331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/19/2021] [Indexed: 02/03/2023]

Al-Ashqar M, Aslam N, Azhar MS, Grayston J, Hahnel J. KingMark's dual-marker versus a conventional single-marker templating system: is there a difference in accuracy of predicting final implant sizes and leg lengths? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023;33:167-175. [PMID: 34842990 DOI: 10.1007/s00590-021-03174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/19/2021] [Indexed: 01/07/2023]

Abstract

AIMS

Pre-operative templating for total hip replacement (THR) surgery leads to more accurate implant sizing and positioning. This study aimed to compare the KingMark™ dual-marker system for magnification calibration to the current gold standard single-marker system in accuracy of predicting implant size and restoration of leg length post-operatively.

METHODS

This is a retrospective analysis of patients who had primary THR surgery from 2013 to 2019 by a single surgeon. Patients were in two cohorts whose operations were completed at separate healthcare facilities. Patients in the first cohort had pre-operative templating using the KingMark system; patients in the second cohort had templating using a single-marker. For all patients, pre-operative radiographs were reviewed; predicted implants noted; and leg length discrepancies calculated. These were compared to post-operative data. We then tested the null hypothesis that there was no difference between the templating methods for prediction accuracy of implant size and achieving restoration of leg length.

RESULTS

A total of 121 patients were included in the KingMark cohort, and 104 were included in the single-marker cohort. In the KingMark cohort, 83.5% of patients had implantation of a cup within one size of that predicted, compared to 71.2% of the single-marker cohort. This superiority was statistically significant. There was a greater proportion of exact cup size predictions in the KingMark cohort, but this was not statistically significant. We did not find any significant difference between the cohorts for stem size, or stem placement, or reduction of leg length discrepancy.

CONCLUSION

We have demonstrated statistically significant superiority of the KingMark over a single-marker templating system for predicting cup size in primary THR surgery. For post-operative restoration of leg length, our study did not show any advantage of KingMark templating compared to single-marker templating.

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Chen X, Wang Y, Ma R, Peng H, Zhu S, Li S, Li S, Dong X, Qiu G, Qian W. Validation of CT-Based Three-Dimensional Preoperative Planning in Comparison with Acetate Templating for Primary Total Hip Arthroplasty. Orthop Surg 2022;14:1152-1160. [PMID: 35524643 PMCID: PMC9163964 DOI: 10.1111/os.13298] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022] Open

Abstract

OBJECTIVE

This study aims to compare the accuracy of CT-based preoperative planning with that of acetate templating in predicting implant size, neck length, and neck cut length, and to evaluate the reproducibility of the two methods.

METHODS

This prospective study was conducted between August 2020 and March 2021. Patients who underwent elective primary total hip arthroplasty by a single surgeon were assessed for eligibility. The included patients underwent both acetate templating and CT-based planning by two observers after the operation. Each observer conducted both acetate templating and CT-based planning twice for each case. The outcome measures included the following: (1) the accuracy of surgical planning in predicting implant size, calcar length, and neck length, which was defined as the difference between the planned size and length and the actual size and length; (2) reproducibility of the two planning techniques, which were assessed by inter-observer and intra-observer reliability analysis; (3) the influence of potential confounding factors on planning accuracy, which was evaluated using generalized estimating equations.

RESULTS

A total of 57 cases were included in the study. CT-based planning was more accurate than acetate templating for predicting cup size (93% vs 79%, p < 0.001) and stem size (93% vs 75%, p < 0.001). When assessed by mean absolute difference, the comparison between acetate templating and CT-based planning was 4.28 mm vs 3.74 mm (p = 0.122) in predicting neck length and 3.05 mm vs 2.93 mm (p = 0.731) in predicting neck cut length. In the inter-observer reliability analysis, an intraclass correlation coefficient (ICC) of 0.790 was achieved for predicting cup size, and an ICC of 0.966 was achieved for predicting stem size using CT-based planning. In terms of intra-observer reliability, Observer 1 achieved an ICC of 0.803 for predicting cup size and 0.965 for predicting stem size in CT-based planning. Observer 2 achieved ICC values of 0.727 and 0.959 for predicting cup and stem sizes, respectively. The average planning time was 6.48 ± 1.55 min for CT-based planning and 6.12 ± 1.40 min for acetate templating (p = 0.015).

CONCLUSION

The CT-based planning system is more accurate than acetate templating for predicting implant size and has good reproducibility in total hip arthroplasty.

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Mirghaderi SP, Sharifpour S, Moharrami A, Ahmadi N, Makuku R, Salimi M, Mortazavi SMJ. Determining the accuracy of preoperative total hip replacement 2D templating using the mediCAD^® software. J Orthop Surg Res 2022;17:222. [PMID: 35399090 PMCID: PMC8996579 DOI: 10.1186/s13018-022-03086-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open

Abstract

BACKGROUND

Templating is a preoperative planning procedure that improves the efficiency of the surgical process and reduces postoperative complications of total hip arthroplasty (THA) by improving the precision of prediction of prosthetic implant size. This study aimed to evaluate the accuracy of the preoperative cup and stem size digital 2D templating of THA with mediCAD® software and find the factors that influence the accuracy, such as indication for surgery, patients' demographics, implant brand, and the assessors' grade of education.

METHODS

We retrospectively retrieved 420 patient template images of all patients who underwent THA between March 2018 and March 2021. Templating of all included images was processed using mediCAD® software a day before surgery by a newcomer physician to hip arthroplasty course (PGY-2 orthopedic resident or hip surgery fellow). Preoperative templating cup and stem sizes were compared with the actual inserted implant sizes.

RESULT

After excluding ineligible patients, this study included 391 patients, 193 (49.4%) males and 198 (50.6%) females with a mean age of 43.3 ± 14.9. The average cup sizes predicted before and after surgery were 52.12 ± 14.28 and 52.21 ± 15.05 respectively, and the mean delta cup size (before and after surgery) was 2.79 ± 2.94. The delta stem size before and after surgery has a mean value of 1.53 ± 1.49. The acetabular cup components, measured within ± 0, ± 1, and ± 2 sizes, were 28.9%, 63.9%, 83.1% accurate, respectively. The femoral stem design component measured within ± 0, ± 1, and ± 2 sizes were 27.2%, 61.0%, 78.6% accurate, respectively. Wagner Cone® stem brand, DDH patients, and females showed significantly higher accuracy of stem size templating. Revision THA has the lowest accuracy in terms of cup size templating. The compression of accuracy rate between resident and fellow revealed no significant differences. Also, no significant difference was detected between the accuracy of templating performed in the first months with the second months of the arthroplasty course period.

CONCLUSION

Our study showed that under mentioned condition, templating using mediCAD® has acceptable accuracy in predicting the sizes of femoral and acetabular components in THA patients. Digital software like mediCAD® remains favorable because of the short learning curve, user-friendly features, and low-cost maintenance, leading to level-up patient care and THA efficacy. Further studies are necessary for clarifying the role of the assessor's experience and expertise in THA preoperative templating.

LEVEL OF EVIDENCE

Level III (retrospective observational study).

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Chen X, Liu X, Wang Y, Ma R, Zhu S, Li S, Li S, Dong X, Li H, Wang G, Wu Y, Zhang Y, Qiu G, Qian W. Development and Validation of an Artificial Intelligence Preoperative Planning System for Total Hip Arthroplasty. Front Med (Lausanne) 2022;9:841202. [PMID: 35391886 PMCID: PMC8981237 DOI: 10.3389/fmed.2022.841202] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open

Affiliation(s)

Xi Chen Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
Xingyu Liu School of Life Sciences, Tsinghua University, Beijing, China Institute of Biomedical and Health Engineering (iBHE), Tsinghua Shenzhen International Graduate School, Shenzhen, China Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China Longwood Valley Medical Technology Co. Ltd., Beijing, China
Yiou Wang Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
Ruichen Ma School of Medicine, Tsinghua University, Beijing, China
Shibai Zhu Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
Shanni Li Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
Songlin Li Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
Xiying Dong Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
Hairui Li Department of Plastic Surgery, Sichuan University West China Hospital, Chengdu, China
Guangzhi Wang Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
Yaojiong Wu Institute of Biomedical and Health Engineering (iBHE), Tsinghua Shenzhen International Graduate School, Shenzhen, China
Yiling Zhang Longwood Valley Medical Technology Co. Ltd., Beijing, China *Correspondence: Yiling Zhang,
Guixing Qiu Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China Guixing Qiu,
Wenwei Qian Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China Wenwei Qian,

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de Waard S, Verboom T, Bech NH, Sierevelt IN, Kerkhoffs GM, Haverkamp D. Femoroacetabular offset restoration in total hip arthroplasty; Digital templating a short stem vs a conventional stem. World J Orthop 2022;13:139-149. [PMID: 35317405 PMCID: PMC8891660 DOI: 10.5312/wjo.v13.i2.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/02/2021] [Accepted: 01/08/2022] [Indexed: 02/06/2023] Open

Abstract

BACKGROUND

Failure in restoring individual anatomy could be a reason for persistent functional limitations post total hip arthroplasty. Femoroacetabular offset (FAO) plays an important role in anatomic restoration, as loss of offset ≥ 5 mm is associated with altered gait and decreased functional outcome. Preoperative assessment by use of digital templating has shown to be a reliable method for sizing the components in total hip arthroplasty, and can show if anatomic restoration is achieved. In recent years, short stems are growing in popularity as it could allow better restoration due to more variety in placement.

AIM

To assess whether restoration of the FAO differs between a short or a conventional stem by use of digital templating. Additionally, association of the preoperative offset and caput-colllum-diaphyseal angle (CCD-angle) within restoration of both stems was investigated, and the reliability of measurements was assessed.

METHODS

A total of 100 standardized hip radiographs were used for digital templating. Restoration of FAO was classified into “restored” or “not restored”, when a < 5 mm or ≥ 5 mm difference from baseline value presented, respectively. Differences between the two stems concerning proportions of correct restoration of the FAO were analyzed by use of McNemar tests. To assess association between CCD-angle and preoperative FAO with absolute FAO restoration, multi-level analysis was performed by use of a linear mixed model to account for paired measurements. Through determination of the optimal point under the curve in operating curve-analysis, bootstrapping of thousand sets was performed to determine the optimal cutoff point of the preoperative FAO for restoration within the limits of 5 mm. Three observers participated for inter-observer reliability, with two observers measuring the radiographs twice for intra-observer reliability.

RESULTS

The mean preoperative FAO was 79.7 mm (range 62.5-113 mm), with a mean CCD-angle of 128.6° (range 114.5°-145°). The conventional stem could only restore the FAO in 72 of the cases, whereas the short stem restored the FAO in all cases. CCD-angle was not a predictor, but the preoperative FAO was. A cut-off point of 81.25 mm (95% confidence interval of 80.75-84.75 mm) in preoperative FAO was found where the conventional stem was unable to restore the FAO. Reliability of measurements was excellent, with an intra-observer reliability of 0.99 and inter-observer reliability in baseline measurements higher than 0.9 between the three observers.

CONCLUSION

In preoperative planning of FAO restoration in total hip arthroplasty, digital templating shows that short stems with a curve following the medial calcar are potentially better at restoring the FAO compared to conventional stems if the preoperative offset is ≥ 80.0 mm.

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Accuracy of digital templating of uncemented total hip arthroplasty at a certified arthroplasty center: a retrospective comparative study. Arch Orthop Trauma Surg 2022;142:2471-2480. [PMID: 33725193 PMCID: PMC9474525 DOI: 10.1007/s00402-021-03836-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/15/2021] [Indexed: 12/04/2022]

Digital templating for the implantation of a curved short hip stem with an anterolateral MIS approach shows gender differences in digital templating. Arch Orthop Trauma Surg 2022;142:1661-1668. [PMID: 34169356 PMCID: PMC9217763 DOI: 10.1007/s00402-021-04005-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 06/17/2021] [Indexed: 11/18/2022]

Abstract

PURPOSE

Digital templating shows reliable accuracy for straight stem systems. In recent years, the implantation of short stems through minimally invasive approaches has gained more popularity. Minimally invasive approaches (MIS) show the risk of undersizing femoral components. Therefore, we questioned the planning adherence for a curved short stem and a bi-hemispherical acetabular cup implanted through an anterolateral MIS approach.

METHODS

A consecutive series of 964 hips (index surgery between 2014 and 2019) with Fitmore^® curved short stem and Allofit/-S^® acetabular cup (both ZimmerBiomet Inc, Warsaw, IN) were included. Preoperative digital templating was conducted anterior-posterior (AP) digital radiographs of the hip using mediCAD^® version 5.1 (Hectec GmbH, Altdorf, Germany). The templates of acetabular and femoral components (offset option and stem size) were retrospectively evaluated for general adherence, and according to sex, BMI and planner's experience.

RESULTS

Planning adherence for the exact offset option was 70.6 and 21.6% for exact offset option and stem size. Adherence for acetabular cup ± 1 size was 74.8%. A significant difference between male and female patients for the offset option could be found (p = 0.03, z = -2983). In 22.5% of male patients, an offset option one size higher and in 12.3% of female patients an offset option one size smaller than templated was used intraoperatively CONCLUSION: Digital templating for the Fitmore^® stem in cementless THA with a minimally invasive anterolateral approach shows comparable planning adherence to the existing literature for this cementless short stem. However, a lower planning adherence was detected compared to conventional straight stem systems. In male patients, the femoral offset is frequently undersized and in female patients frequently oversized compared to the preoperative plan. Surgeons should be aware of this difficulty in digital templating for Fitmore^® hip stem.

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Smith JBV, Bishi H, Wang C, Asopa V, Field RE, Sochart DH. The accuracy and reliability of preoperative digital 2D templating in prosthesis size prediction in uncemented versus cemented total hip arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021;6:1020-1039. [PMID: 34909222 PMCID: PMC8631246 DOI: 10.1302/2058-5241.6.210048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open

Abstract

The purpose of this study was to compare the accuracy and the inter- and intra-observer reliability of preoperative digital 2D templating in prosthesis size prediction for the planning of cemented or uncemented THA.

This study was registered in the NIHR PROSPERO database (ID: CRD42020216649) and conducted according to the PRISMA guidelines. A search of electronic databases in March 2021 found 29 papers overall. The quality of evidence was assessed using the IHE Quality Appraisal of Case Series Studies Checklist and the CASP Randomised Controlled Trials Checklist. A meta-analysis was conducted, and the accuracy was presented as proportions and the inter- and intra-observer reliability were measured using intraclass correlation coefficients (ICC).

Accuracy within one prosthesis size (±1) for cemented stems was 0.89 (95% confidence interval (CI) 0.83–0.95), cemented cups 0.78 (95% CI 0.67–0.89), uncemented stems 0.74 (95% CI 0.66–0.82) and uncemented cups 0.73 (95% CI 0.67–0.79) (test of group differences: p = 0.010). Inter-observer reliability (ICC) for uncemented cups was 0.88 (95% CI 0.85–0.91), uncemented stems 0.86 (95% CI 0.81–0.91), cemented stems 0.69 (95% CI 0.54–0.84) and cemented cups 0.68 (95% CI 0.55–0.81) (test of group differences: p = 0.004). Due to lack of data, intra-observer reliability (ICC) could only be calculated for uncemented prostheses, which for the stems was 0.90 (95% CI 0.88–0.92) and for the cups was 0.87 (95% CI 0.83–0.90) (test of group differences: p = 0.124).

The accuracy of preoperative digital templating is greater for cemented prostheses, but the inter-observer reliability is greater for uncemented prostheses. The intra-observer reliability showed a high level of agreement for uncemented prostheses.

Cite this article: EFORT Open Rev 2021;6:1020-1039. DOI: 10.1302/2058-5241.6.210048

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Sahemey R, Moores TS, Meacher H, Youssef B, Khan S, Evans CR. Anthropometric method for estimating component sizes in total hip arthroplasty. World J Orthop 2021;12:859-866. [PMID: 34888146 PMCID: PMC8613690 DOI: 10.5312/wjo.v12.i11.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/14/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open

Abstract

BACKGROUND

Preoperative templating is essential in total hip arthroplasty (THA) as it not only helps to facilitate the correct implant type and size but also determines the post-operative biomechanics. Templating is also increasingly important from a medico-legal perspective and recommended in the British Orthopaedic Association Guide to Good Practice. Although templating has become increasingly digitised, there are no simple anthropometric models to predict implant sizes in the absence of digital methods.

AIM

To assess the accuracy of using an easily obtainable measurement (shoe size) to predict component sizes in THA compared with digital templating.

METHODS

Digital radiographs from a cohort of 102 patients (40 male, 62 female) who had undergone uncemented or hybrid THA at a single centre were retrospectively templated to desired cup and stem sizes using TraumaCad^®. We compared the templated size to the actual size of the implant and assessed if there was any correlation with the patient’s shoe size.

RESULTS

Statistically significant positive correlations were observed between: shoe size and templated cup size (ρ = 0.92, P < 0.001); shoe size with implanted cup size (ρ = 0.71, P < 0.001); shoe size and templated stem size (ρ = 0.87, P < 0.001); and shoe size with implanted stem size (ρ = 0.57, P < 0.001). Templated and implanted acetabular cup sizes were positively correlated (ρ = 0.76, P < 0.001) and were exact in 43.1% cases; 80.4% of implanted cup sizes were within 1 size (+/- 2 mm) of the template and 100% within 2 sizes (+/- 4 mm). Positive correlation was also demonstrated between templated and implanted femoral stem sizes (ρ = 0.69, P < 0.001) and were exact in 52.6% cases; 92.6% were within 1 size of the template and 98% within 2 sizes.

CONCLUSION

This study has shown there to be a significant positive correlation between shoe size and templated size. Anthropometric measurements are easily obtainable and can be used to predict uncemented component sizes in the absence of digital methods.

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Kristoffersson E, Otten V, Crnalic S. The accuracy of digital templating in cementless total hip arthroplasty in dysplastic hips. BMC Musculoskelet Disord 2021;22:942. [PMID: 34758811 PMCID: PMC8582185 DOI: 10.1186/s12891-021-04793-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open

Shichman I, Shaked O, Morgan S, Garceau S, Snir N, Warschawski Y. Digital templating in total hip arthroplasty using contralateral healthy hip results in decreased accuracy. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]

Holliday M, Steward A. Pre-operative templating for total hip arthroplasty: How does radiographic technique and calibration marker placement affect image magnification? J Med Radiat Sci 2021;68:228-236. [PMID: 33590673 PMCID: PMC8424328 DOI: 10.1002/jmrs.461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022] Open

Pongkunakorn A, Aksornthung C, Sritumpinit N. Accuracy of a New Digital Templating Method for Total Hip Arthroplasty Using Picture Archiving and Communication System (PACS) and iPhone Technology: Comparison With Acetate Templating on Digital Radiography. J Arthroplasty 2021;36:2204-2210. [PMID: 33583670 DOI: 10.1016/j.arth.2021.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023] Open

Goyal T, Sethy SS, Ansari S, Das L, Paul S. Use of Acetate Templates Over Digital Radiographs for Templating in Total Hip Arthroplasty: Technique and Its Validation. Indian J Orthop 2021;55:81-87. [PMID: 34122759 PMCID: PMC8149513 DOI: 10.1007/s43465-020-00300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]

Buller LT, McLawhorn AS, Maratt JD, Carroll KM, Mayman DJ. EOS Imaging is Accurate and Reproducible for Preoperative Total Hip Arthroplasty Templating. J Arthroplasty 2021;36:1143-1148. [PMID: 33616064 DOI: 10.1016/j.arth.2020.09.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023] Open

Brenneis M, Braun S, van Drongelen S, Fey B, Tarhan T, Stief F, Meurer A. Accuracy of Preoperative Templating in Total Hip Arthroplasty With Special Focus on Stem Morphology: A Randomized Comparison Between Common Digital and Three-Dimensional Planning Using Biplanar Radiographs. J Arthroplasty 2021;36:1149-1155. [PMID: 33160804 DOI: 10.1016/j.arth.2020.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open

Huo J, Huang G, Han D, Wang X, Bu Y, Chen Y, Cai D, Zhao C. Value of 3D preoperative planning for primary total hip arthroplasty based on artificial intelligence technology. J Orthop Surg Res 2021;16:156. [PMID: 33627149 PMCID: PMC7903792 DOI: 10.1186/s13018-021-02294-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/10/2021] [Indexed: 12/18/2022] Open

Abstract

Background

Accurate preoperative planning is an important step for accurate reconstruction in total hip arthroplasty (THA). Presently, preoperative planning is completed using either a two-dimensional (2D) template or three-dimensional (3D) mimics software. With the development of artificial intelligence (AI) technology, AI HIP, a planning software based on AI technology, can quickly and automatically identify acetabular and femur morphology, and automatically match the optimal prosthesis size. However, the accuracy and feasibility of its clinical application still needs to be further verified. The purposes of this study were to investigate the accuracy and time efficiency of AI HIP in preoperative planning for primary THA, compared with 3D mimics software and 2D digital template, and further analyze the factors that influence the accuracy of AI HIP.

Methods

A prospective study was conducted on 53 consecutive patients (59 hips) undergoing primary THA with cementless prostheses in our department. All preoperative planning was completed using AI HIP as well as 3D mimics and 2D digital template. The predicted component size and the actual implantation results were compared to determine the accuracy. The templating time was compared to determine the efficiency. Furthermore, the potential factors influencing the accuracy of AI HIP were analyzed including sex, body mass index (BMI), and hip dysplasia.

Results

The accuracy of predicting the size of acetabular cup and femoral stem was 74.58% and 71.19%, respectively, for AI HIP; 71.19% (P = 0.743) and 76.27% (P = 0.468), respectively, for 3D mimics; and 40.68% (P < 0.001) and 49.15% (P = 0.021), respectively, for 2D digital templating. The templating time using AI HIP was 3.91 ± 0.64 min, which was equivalent to 2D digital templates (2.96 ± 0.48 min, P < 0.001), but shorter than 3D mimics (32.07 ± 2.41 min, P < 0.001). Acetabular dysplasia (P = 0.021), rather than sex and BMI, was an influential factor in the accuracy of AI HIP templating. Compared to patients with developmental dysplasia of the hip (DDH), the accuracy of acetabular cup in the non-DDH group was better (P = 0.021), but the difference in the accuracy of the femoral stem between the two groups was statistically insignificant (P = 0.062).

Conclusion

AI HIP showed excellent reliability for component size in THA. Acetabular dysplasia may affect the accuracy of AI HIP templating.

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Waldstein W, Bouché PA, Pottmann C, Faschingbauer M, Aldinger PR, Windhager R, Merle C. Quantitative and individualized assessment of the learning curve in preoperative planning of the acetabular cup size in primary total hip arthroplasty. Arch Orthop Trauma Surg 2021;141:1601-1608. [PMID: 33709204 PMCID: PMC8354891 DOI: 10.1007/s00402-021-03848-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 02/27/2021] [Indexed: 11/27/2022]

Abstract

INTRODUCTION

The aim of the present study was to investigate the learning curves of 2 trainees with different experience levels to reach proficiency in preoperative planning of the cup size based on learning curve cumulative summation (LC-CUSUM) statistics and a cumulative summation (CUSUM) test.

MATERIALS AND METHODS

One-hundred-twenty patients who had undergone primary total hip arthroplasty with a cementless cup were selected. Preoperative planning was performed by an experienced orthopedic surgeon. Trainee 1 (student) and trainee 2 (resident) planned the cup size. The trainees were blinded to the preoperative plan and the definitive cup size. Only after a cup size was chosen, the trainees were unblinded to the preoperative plan of the surgeon. LC-CUSUM was applied to both trainees to determine when proficiency in determining the appropriate cup size was reached. A CUSUM test was applied to ensure retention of proficiency.

RESULTS

With reference to the preoperative plan of the surgeon, LC-CUSUM indicated proficiency after 94 planning attempts for trainee 1 and proficiency after 66 attempts for trainee 2, respectively. Trainee 1 and 2 maintained proficiency thereafter. With reference to the definitive cup size, LC-CUSUM did not signal competency within the first 120 planning attempts for trainee 1. Trainee 2 was declared competent after 103 attempts and retained competency thereafter.

CONCLUSIONS

LC-CUSUM/CUSUM allow for an individualized, quantitative and continuous assessment of planning quality. Based on LC-CUSUM statistics, the two trainees of this study gain proficiency in planning of the acetabular cup size after 50-100 attempts when an immediate feedback is provided. Previous experience positively influences the performance. The study serves as basis for the medical education of students and residents in joint replacement procedures.

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Di Laura A, Henckel J, Hothi H, Hart A. Can 3D surgical planning and patient specific instrumentation reduce hip implant inventory? A prospective study. 3D Print Med 2020;6:25. [PMID: 32965588 PMCID: PMC7513524 DOI: 10.1186/s41205-020-00077-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open

Montiel V, Troncoso S, Valentí-Azcárate A, Valentí-Nin JR, Lamo-Espinosa JM. Total Hip Arthroplasty Digital Templating: Size Predicting Ability and Interobserver Variability. Indian J Orthop 2020;54:840-847. [PMID: 33133407 PMCID: PMC7572938 DOI: 10.1007/s43465-020-00217-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 02/04/2023]

Zhang HL, Zheng L, Wang WC, Luo YH, Wang L, Mao XZ. A new and improved acetabular cup digital templating method and its clinical application. Musculoskelet Surg 2020;106:49-58. [PMID: 32617748 DOI: 10.1007/s12306-020-00671-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/05/2020] [Indexed: 12/17/2022]

Abstract

BACKGROUND AND OBJECTIVE

Preoperative acetabular cup templating has an important auxiliary effect on hip surgery. The traditional acetabular cup templating method requires the measuring person to have some experience in total hip replacement (THA) surgery since the measurement results vary from person to person with differences between different measuring persons. To obtain stable templating results, we designed a new acetabular cup templating method and tested the inter-person measuring differences and measurement accuracy of this method. Meanwhile, the clinical application of this method was preliminarily explored.

MATERIALS AND METHODS

The pattern of this new method was manual labeling of imaging characteristic points and then programmed automatic measurements. The measurement process was performed entirely by orthopedic graduate students without any experience in hip replacement surgery. The inter-person measuring difference was evaluated by comparing the templating results of three measuring persons. The accuracy of the templating was evaluated by comparing the templating results with the actual size of the prosthesis in the surgery. The correlation between the position of the acetabular cup and the templating error was analyzed to explore the clinical significance of the templating results. This study was a retrospective study which included templating in a total of 406 cases for total hip replacement with cementless cup prosthesis. Digital measurements were performed using the Matlab software from MathWorks. The statistical comparison was performed using Kendall's W test.

RESULTS

The results of the three measuring persons were completely identical in 61.8% (251/406) of cases, and the variation in 38.2% (155/406) of cases did not exceed one size of the acetabular cup. The Kendall's W coefficient was 0.977, and p < 0.01. The measurement accuracy is not as good as the traditional method in exactly accurate measurement and ±1 cup size, but it is similar to the traditional method in the ±2 cup sizes. The correlation between the templating error and the position evaluation of the implanted acetabular cups reveals: (1) larger the templating error, larger the proportion of the acetabular cups with poor position; (2) the proportion of acetabular cup with poor position slowly increased when the templating error was from 0 to 1 size, and the proportion rapidly increased when the templating error was from 1 to 2 size.

CONCLUSION

All the patients with clear teardrop bottom and lateral superior edge of acetabulum were able to use our method to predict the size of the acetabular cup. The method has the following advantages: (1) it does not require the measuring person to have any previous experience of the THA surgery, which reduces the labor cost of the templating; (2) the differences between the measuring persons is small, the measurement result can be repeated; (3) it can predict the probability of acetabular cup with poor positioning according to the templating error, and thereby reminding the surgeon to recheck and correct the position of the acetabular cup in time during the surgery.

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Colombi A, Schena D, Castelli CC. Total hip arthroplasty planning. EFORT Open Rev 2019;4:626-632. [PMID: 31754469 PMCID: PMC6851526 DOI: 10.1302/2058-5241.4.180075] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open

Schiffner E, Latz D, Jungbluth P, Grassmann JP, Tanner S, Karbowski A, Windolf J, Schneppendahl J. Is computerised 3D templating more accurate than 2D templating to predict size of components in primary total hip arthroplasty? Hip Int 2019;29:270-275. [PMID: 29781288 DOI: 10.1177/1120700018776311] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]

Pachter CS, Garfinkel JH, Romness DW, Gladnick BP. Radiographic Calibration With a Prosthetic Femoral Head Allows Accurate Preoperative Templating for Total Hip Arthroplasty. Orthopedics 2019;42:e346-e349. [PMID: 30913298 DOI: 10.3928/01477447-20190321-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/10/2018] [Indexed: 02/03/2023]

Alnahhal A, Aslam-Pervez N, Sheikh HQ. Templating Hip Arthroplasty. Open Access Maced J Med Sci 2019;7:672-685. [PMID: 30894933 PMCID: PMC6420946 DOI: 10.3889/oamjms.2019.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/16/2022] Open

Boese CK, Wilhelm S, Haneder S, Lechler P, Eysel P, Bredow J. Influence of calibration on digital templating of hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018;43:1799-1805. [PMID: 30132182 DOI: 10.1007/s00264-018-4120-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/15/2018] [Indexed: 01/25/2023]

Ogawa T, Takao M, Sakai T, Sugano N. Factors related to disagreement in implant size between preoperative CT-based planning and the actual implants used intraoperatively for total hip arthroplasty. Int J Comput Assist Radiol Surg 2017;13:551-562. [DOI: 10.1007/s11548-017-1693-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/06/2017] [Indexed: 12/20/2022]

Archibeck MJ, Tripuraneni KR, Carothers JT, Junick DW, Munson NR, Murray-Krezan CM. Prospective, Randomized, Surgeon-Blinded Comparison of Standard Magnification Assumption vs Magnification Marker Usage for Preoperative Templating in Total Hip Arthroplasty. J Arthroplasty 2017;32:3061-3064. [PMID: 28602530 DOI: 10.1016/j.arth.2017.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 04/09/2017] [Accepted: 05/08/2017] [Indexed: 02/01/2023] Open

Mainard D, Barbier O, Knafo Y, Belleville R, Mainard-Simard L, Gross JB. Accuracy and reproducibility of preoperative three-dimensional planning for total hip arthroplasty using biplanar low-dose radiographs : A pilot study. Orthop Traumatol Surg Res 2017;103:531-536. [PMID: 28323248 DOI: 10.1016/j.otsr.2017.03.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/23/2017] [Accepted: 03/09/2017] [Indexed: 02/02/2023]

Abstract

BACKGROUND

In total hip arthroplasty (THA), the acetabular cup and femoral stem must be correctly sized and positioned to avoid intraoperative and postoperative complications, achieve good functional outcomes and ensure long-term survival. Current two-dimensional (2D) techniques do not provide sufficient accuracy, while low-dose biplanar X-rays (EOS) had not been assessed in this indication. Therefore, we performed a case-control study to : (1) evaluate the prediction of stem and cup size for a new 3D planning technique (stereoradiographic imaging plus 3D modeling) in comparison to 2D templating on film radiographs and (2) evaluate the accuracy and reproducibility of this 3D technique for preoperative THA planning.

HYPOTHESIS

Accuracy and reproducibility are better with the 3D vs. 2D method.

PATIENTS AND METHODS

Stem and cup sizes were retrospectively determined by two senior surgeons, twice, for a total of 31 unilateral primary THA patients in this pilot study, using 3D preplanning software on low-dose biplanar X-rays and with 2D templating on conventional anteroposterior (AP) film radiographs. Patients with a modular neck or dual-mobility prosthesis were excluded. All patients but one had primary osteoarthritis; one following trauma did not have a cup implanted. The retrospectively planned sizes were compared to the sizes selected during surgery, and intraclass coefficients (ICC) calculated.

RESULTS

3D planning predicted stem size more accurately than 2D templating: stem sizes were planned within one size in 26/31 (84%) of cases in 3D versus 21/31 (68%) in 2D (P=0.04). 3D and 2D planning accuracies were not significantly different for cup size: cup sizes were planned within one size in 28/30 (92%) of cases in 3D versus 26/30 (87%) in 2D (P=0.30). ICC for stem size were 0.88 vs. 0.91 for 3D and 2D, respectively. Inter-operator ICCs for cup size were 0.84 vs. 0.71, respectively. Repetitions of the 3D planning were within one size (except one stem), with the majority predicting the same size.

DISCUSSION

Increased accuracy in 3D may be due to the use of actual size (non-magnified) images, and judging fit on AP and lateral images simultaneously. Results for other implant components may differ from those presented. Size selection may improve further with planning experience, based on a feedback loop between planning and surgical execution.

LEVEL OF EVIDENCE

Level III. Retrospective case-control study.

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Shemesh SS, Robinson J, Keswani A, Bronson MJ, Moucha CS, Chen D. The Accuracy of Digital Templating for Primary Total Hip Arthroplasty: Is There a Difference Between Direct Anterior and Posterior Approaches? J Arthroplasty 2017;32:1884-1889. [PMID: 28108172 DOI: 10.1016/j.arth.2016.12.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/29/2016] [Accepted: 12/17/2016] [Indexed: 02/06/2023] Open

Wang Q, Xiao J, Zhu L, Zhao X, Liu Z, Wang J, Qin Y. Acetate templating on calibrated standing digital radiograph improves accuracy of preoperative templating for total hip arthroplasty. Orthop Traumatol Surg Res 2017;103:341-347. [PMID: 28263807 DOI: 10.1016/j.otsr.2016.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 12/27/2016] [Accepted: 12/29/2016] [Indexed: 02/09/2023]

Abstract

BACKGROUND

The accuracy of preoperative templating with respect to leg length, femoral offset, and the size of femoral and acetabular components is essential to the success of total hip arthroplasty (THA). Traditionally, templating has been performed using printed film with acetate templates. However, preoperative templating designed by different prosthetic manufacturers cannot be used directly on the film due to varying acetate template amplification ratios. Computer-based templating needs specialized digital templating software, which has cost implications. To address these shortcomings, we bring forward several questions: (1) the accuracy of traditional manual templating combined with the calibrated digital radiograph for preoperative templating, (2) the inter- and intraobserver reliability of this method.

HYPOTHESIS

Using calibrated digital radiograph with traditional manual templating improves the accuracy and reproducibility of preoperative templating for THA.

PATIENTS AND METHODS

We designed a stepwise method that combines the traditional manual templating with standing digital radiograph calibrated by a scaling ball. Two separate observers (XJL, QYG) analyzed data of 82 patients (109 THAs) who had undergone THA with preoperative templating using the calibrated digital templating. The intra- and interobserver reliability was assessed by intraclass correlation coefficient.

RESULTS

The size of the acetate template acetabular based on our method was identical to the actual implanted acetabular size in 55.0% (XJL 110/218 [50.5%]; QYG 130/218 [59.6%]) of the cases indicating moderate accuracy. The intraclass correlation coefficient (ICC) for acetabular templating indicated almost perfect interobserver (ICC=0.918 [95% CI, 0.893-0.937]) and intraobserver agreement (ICC=0.932 [95% CI, 0.912-0.947]). While the exact implanted femoral size was predicted in 55.3% (XJL 122/218 [56.0%]; QYG 119/218 [54.6%]) of the cases. The ICC for femoral component templating indicated almost perfect interobserver (ICC=0.944 [95% CI, 0.927-0.957]) and intraobserver agreement (ICC=0.909 [95% CI, 0.883-0.930]).

DISCUSSION

This new stepwise method may prove to be a more reliable preoperative design choice to accurately calibrate magnification with radiograph, and could solve the incompatibility of the preoperative template designed by different prosthetic companies for direct use with the x-ray film. The method described is practical, convenient, cost-effective and does not require specialized equipment or software, thus making it particularly suitable for use in underdeveloped settings.

LEVEL OF EVIDENCE

Level IV, case series without controls.

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Sershon RA, Diaz A, Bohl DD, Levine BR. Effect of Body Mass Index on Digital Templating for Total Hip Arthroplasty. J Arthroplasty 2017;32:1024-1026. [PMID: 27776900 DOI: 10.1016/j.arth.2016.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/07/2016] [Accepted: 09/08/2016] [Indexed: 02/01/2023] Open