Hip Pelvis.  2016 Dec;28(4):201-207. 10.5371/hp.2016.28.4.201.

Accuracy and Reliability of Preoperative On-screen Templating Using Digital Radiographs for Total Hip Arthroplasty

• Shin JK
• Son SM
• Kim TW
• Shin WC
• Lee JS
• Suh KT

• KMID: 2364697
• DOI: http://doi.org/10.5371/hp.2016.28.4.201

Abstract

PURPOSE
Preoperative on-screen templating is a method of using acetate templates on digital images. The aim of the present study was to evaluate the accuracy, intra- and interobserver reliabilities of preoperative on-screen templating using digital radiographs for total hip arthroplasty (THA).
MATERIALS AND METHODS
Two hundred patients with hip disease who were treated with primary cementless THA were retrospectively evaluated. The accuracy of on-screen templating was assessed by comparing the predicted prosthesis sizes with the actual sizes used operatively. The inter- and intraobserver reliabilities of the templating results were also evaluated.
RESULTS
The prosthesis prediction accuracy within ±one size was 96.6% for the cup size and 97.8% for the stem size. The inter- and intraobserver reliabilities for the implant size were substantial (kappa>0.70). The intra- and interobserver reliabilities for the leg length discrepancy and femoral offset difference using the intraclass correlation coefficient ranged from 0.89 to 0.97.
CONCLUSION
Preoperative on-screen templating using digital radiographs showed substantial accuracy and reliability for implant prediction. It is an effective method for predicting the size of implant, correcting the leg length discrepancy and restoring the femoral offset.

Keyword

Hip; Total hip arthroplasty; Digital radiography; Acetate template

MeSH Terms

Arthroplasty, Replacement, Hip*
Hip
Humans
Leg
Methods
Prostheses and Implants
Radiographic Image Enhancement
Retrospective Studies

Figure

• 

  Fig. 1 Preoperative on-screen templating is a method to use acetate template on digital radiographs.

• 

  Fig. 2 The size of this image was 48% enlarged using the zoom function of the picture archiving and communications system (PACS), so the size of the radiopaque bar was measured its true size of 10 cm, using the magnified ruled line scale on the templates.

• 

  Fig. 3 The final step of the on-screen templating process is determination of the femoral neck resection level and the offset reconstruction. The femoral head center of the femoral template is placed 5 mm higher than the marked center of the acetabular template to restore the leg length.

Reference

1. Crooijmans HJ, Laumen AM, van Pul C, van Mourik JB. A new digital preoperative planning method for total hip arthroplasties. Clin Orthop Relat Res. 2009; 467:909–916. PMID: 18781367.

2. Iorio R, Siegel J, Specht LM, Tilzey JF, Hartman A, Healy WL. A comparison of acetate vs digital templating for preoperative planning of total hip arthroplasty: is digital templating accurate and safe? J Arthroplasty. 2009; 24:175–179. PMID: 18534425.

3. Suh KT, Cheon SJ, Kim DW. Comparison of preoperative templating with postoperative assessment in cementless total hip arthroplasty. Acta Orthop Scand. 2004; 75:40–44. PMID: 15022804.

4. Unnanuntana A, Wagner D, Goodman SB. The accuracy of preoperative templating in cementless total hip arthroplasty. J Arthroplasty. 2009; 24:180–186. PMID: 18534455.

5. Archibeck MJ, Cummins T, Tripuraneni KR, et al. Inaccuracies in the use of magnification markers in digital hip radiographs. Clin Orthop Relat Res. 2016; 474:1812–1817. PMID: 26797909.

6. Charles MN, Bourne RB, Davey JR, Greenwald AS, Morrey BF, Rorabeck CH. Soft-tissue balancing of the hip: the role of femoral offset restoration. Instr Course Lect. 2005; 54:131–141. PMID: 15948440.

7. Gamble P, de Beer J, Petruccelli D, Winemaker M. The accuracy of digital templating in uncemented total hip arthroplasty. J Arthroplasty. 2010; 25:529–532. PMID: 19493647.

8. González Della Valle A, Comba F, Taveras N, Salvati EA. The utility and precision of analogue and digital preoperative planning for total hip arthroplasty. Int Orthop. 2008; 32:289–294. PMID: 17404731.

9. The B, Diercks RL, van Ooijen PM, van Horn JR. Comparison of analog and digital preoperative planning in total hip and knee arthroplasties. A prospective study of 173 hips and 65 total knees. Acta Orthop. 2005; 76:78–84. PMID: 15788312.

10. Kim MS, Jeong MC, Ji NG, Lee JS, Kim JI, Suh KT. Preoperative templating in PACS for total hip replacement. J Korean Orthop Assoc. 2011; 46:472–477.

11. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33:159–174. PMID: 843571.

12. Bono JV. Digital templating in total hip arthroplasty. J Bone Joint Surg Am. 2004; 86-A(Suppl 2):118–122.

13. Krishnamoorthy VP, Perumal R, Daniel AJ, Poonnoose PM. Accuracy of templating the acetabular cup size in Total Hip Replacement using conventional acetate templates on digital radiographs. J Clin Orthop Trauma. 2015; 6:215–219. PMID: 26566332.

14. Berstock JR, Webb JC, Spencer RF. A comparison of digital and manual templating using PACS images. Ann R Coll Surg Engl. 2010; 92:73–74. PMID: 20056068.

15. Meyer C, Kotecha A, Richards O, Isbister E. Acetate templating for total hip arthroplasty using PACS. Ann R Coll Surg Engl. 2009; 91:162–163. PMID: 19317940.

16. Oddy MJ, Jones MJ, Pendegrass CJ, Pilling JR, Wimhurst JA. Assessment of reproducibility and accuracy in templating hybrid total hip arthroplasty using digital radiographs. J Bone Joint Surg Br. 2006; 88:581–585. PMID: 16645101.

17. Petretta R, Strelzow J, Ohly NE, Misur P, Masri BA. Acetate templating on digital images is more accurate than computer-based templating for total hip arthroplasty. Clin Orthop Relat Res. 2015; 473:3752–3759. PMID: 25910779.

18. Whiddon DR, Bono JV. Digital templating in total hip arthroplasty. Instr Course Lect. 2008; 57:273–279. PMID: 18399591.

19. Bertz A, Indrekvam K, Ahmed M, Englund E, Sayed-Noor AS. Validity and reliability of preoperative templating in total hip arthroplasty using a digital templating system. Skeletal Radiol. 2012; 41:1245–1249. PMID: 22588597.

20. Davila JA, Kransdorf MJ, Duffy GP. Surgical planning of total hip arthroplasty: accuracy of computer-assisted EndoMap software in predicting component size. Skeletal Radiol. 2006; 35:390–393. PMID: 16572344.

21. Eggli S, Pisan M, Müller ME. The value of preoperative planning for total hip arthroplasty. J Bone Joint Surg Br. 1998; 80:382–390. PMID: 9619923.

22. Knight JL, Atwater RD. Preoperative planning for total hip arthroplasty. Quantitating its utility and precision. J Arthroplasty. 1992; 7(Suppl):403–409. PMID: 1431923.

23. Kumar PG, Kirmani SJ, Humberg H, Kavarthapu V, Li P. Reproducibility and accuracy of templating uncemented THA with digital radiographic and digital TraumaCad templating software. Orthopedics. 2009; 32:815. PMID: 19902895.

24. 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; 28:331–337. PMID: 22854351.

25. Steinberg EL, Shasha N, Menahem A, Dekel S. Preoperative planning of total hip replacement using the TraumaCad™ system. Arch Orthop Trauma Surg. 2010; 130:1429–1432. PMID: 20069428.

26. Bracey DN, Seyler TM, Shields JS, Leng X, Jinnah RH, Lang JE. A comparison of acetate and digital templating for hip resurfacing. Am J Orthop (Belle Mead NJ). 2014; 43:E19–E24. PMID: 24490189.

27. Carter LW, Stovall DO, Young TR. Determination of accuracy of preoperative templating of noncemented femoral prostheses. J Arthroplasty. 1995; 10:507–513. PMID: 8523011.

28. Tripuraneni KR, Archibeck MJ, Junick DW, Carothers JT, White RE. Common errors in the execution of preoperative templating for primary total hip arthroplasty. J Arthroplasty. 2010; 25:1235–1239. PMID: 20022456.