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Archives of Orthopaedic and Trauma Surgery

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01-04-2020 | Computed Tomography | Hip Arthroplasty

Pre-operative templating in THA. Part II: a CT-based strategy to correct architectural hip deformities

Authors: Hideo Kobayashi, Alexandre Cech, Masanori Kase, Geert Pagenstart, Yannick Carrillon, Padhraig F. O’Loughlin, Hugo Bothorel, Tarik Aït-Si-Selmi, Michel P. Bonnin

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2020

Abstract

Introduction

Pre-operative templating for total hip arthroplasty (THA) remains inaccurate due to improper magnification and alignment. We aimed to describe an improved templating strategy using computed tomography (CT) to predict component sizes and offsets with greater accuracy.

Materials and methods

We analysed 184 CT images acquired for pre-operative templating of primary THA. We aimed to restore native (pre-arthritic) femoral offset and limb length, by raising the head center to the level of the templated cup center cranio-caudally, but maintaining the pathologic (pre-operative) head center medio-laterally (except in medialized hips). Acetabular offset (AO) and femoral offset (FO) were measured on pre-operative CT scans, during acetate templating, and on post-operative true antero-posterior radiographs.

Results

The post-operative offsets were within ± 5 mm from templated estimates in 174 hips (91%) for AO, in 116 hips (61%) for FO, in 111 hips (58%) for GO, and in 134 hips (70%) for neck cut level. The post-operative hip architecture reproduced the templated hip architecture within ±5 mm in 77 hips (40%). The agreement between planned and post-operative parameters was moderate for stem size (0.57), cup size (0.62), AO (0.50), but fair for FO (0.45). The AO decreased in most arthritic types, notably in lateralized hips (6.6 mm), but remained unchanged in medialized hips. The FO increased in most arthritic types (1.8–3.1 mm) but remained unchanged in medialized and lateralized hips.

Conclusions

We described a strategy for pre-operative templating in THA. Despite the accuracy of CT, the authors found significant variations between planned and post-operative reconstructions, which suggest that pre-operative templating should only be used as an approximate guide.

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Title: Pre-operative templating in THA. Part II: a CT-based strategy to correct architectural hip deformities
Authors: Hideo Kobayashi
Alexandre Cech
Masanori Kase
Geert Pagenstart
Yannick Carrillon
Padhraig F. O’Loughlin
Hugo Bothorel
Tarik Aït-Si-Selmi
Michel P. Bonnin
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 4/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-020-03341-6

At a glance: The STEP trials

Springer Medicine

Pre-operative templating in THA. Part II: a CT-based strategy to correct architectural hip deformities

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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