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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 2/2019

Open Access 01-02-2019 | Hip Arthroplasty

The accuracy of digital templating in uncemented total hip arthroplasty

Authors: Lukas A. Holzer, Georg Scholler, Stefan Wagner, Jörg Friesenbichler, Werner Maurer-Ertl, Andreas Leithner

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2019

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Abstract

Introduction

Preoperative planning is an essential part of total hip arthroplasty (THA). It facilitates the surgical procedure, helps to provide the correct implant size and aims at restoring biomechanical conditions. In recent times, surgeons rely more and more on digital templating techniques. Although the conversion to picture archiving and communication system had many positive effects, there are still problems that have to be taken into consideration.

Objectives

The core objective was to evaluate the impact of the planners’ experience on the accuracy of predicting component size in digital preoperative templating of THA. In addition, the influence of overweight and obesity (according to WHO-criteria), patient’s sex and component design on the accuracy of preoperative planning have been analysed.

Materials and methods

The retrospective study included 632 consecutive patients who had primary uncemented THA. Digital templating was done using “syngo—EndoMap” software by Siemens Medical Solutions AG. Mann–Whitney U test and Kruskal–Wallis test have been used for statistical analysis.
The accuracy of predicting component size has been evaluated by comparing preoperative planned sizes with implanted sizes as documented by the surgeons. The planner’s experience was tested by comparing the reliability of preoperative planning done by senior surgeons or residents. The influence of BMI on predicting component size has been tested by comparing the accuracy of digital templating between different groups of BMI according to WHO-criteria. The same procedure has been done for evaluating the impact of patient´s sex and component design.

Results

The implant size was predicted exactly in 42% for the femoral and in 37% for the acetabular component. 87% of the femoral components and 78% of the acetabular cups were accurate within one size. Digital templating of femoral implant size was significantly more reliable when done by a senior surgeon. No difference was found for the acetabular component sizes. The BMI also had an impact on estimating the correct femoral implant size. In overweight patients, planning was significantly more inaccurate than normal weight people. Differences were seen in obese patients. However, these were not significant. Accuracy of acetabular components was not affected. The design of the prostheses and the patient’s sex had no influence on predicting component size.

Conclusions

Inexperience and overweight are factors that correlate with inaccuracy of preoperative digital templating in femoral components, whereas acetabular components seem to be independent of these factors.
Footnotes
1
U(261,371) = 44.060.
 
2
U(261, 370) = 49.628.
 
3
U(469, 163) = 36.211.
 
4
U(469, 162) = 37.562.
 
5
U(282, 350) = 52.528.
 
6
U(281,350) = 53.159.
 
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Metadata
Title
The accuracy of digital templating in uncemented total hip arthroplasty
Authors
Lukas A. Holzer
Georg Scholler
Stefan Wagner
Jörg Friesenbichler
Werner Maurer-Ertl
Andreas Leithner
Publication date
01-02-2019
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 2/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-018-3080-0

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