Abstract
Purpose
The purpose of this study was to evaluate the use of pre-operative digital templating to minimize complications including limb length discrepancy (LLD), intraoperative fractures and early dislocations in patients with intracapsular femoral neck fractures.
Methods
We retrospectively compared 23 patients undergoing total hip arthroplasty (THA) for intracapsular femoral fractures with pre-operative digital templating and 48 patients without templating.
Results
The mean post-operative LLD was significantly lower in patients who had pre-operative templating than in the control group (6.7 vs. 11.5 mm, p = 0.023). Only three patients (13 %) with templating had LLD greater than 1.5 cm, compared to the 15 patients (31 %) without templating (p = 0.17). In eight cases the final femoral stem size matched the templated size, while 19 patients were within two size increments. Complications included one dislocation and one intra-operative fracture in the control group.
Conclusion
The present study demonstrated that careful pre-operative planning may reduce LLD in patients undergoing THA due to intracapsular hip fractures.
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References
Eggli S, Pisan M, Müller ME (1998) The value of preoperative planning for total hip arthroplasty. J Bone Joint Surg (Br) 80(3):382–390
Knight JL, Atwater RD (1992) Preoperative planning for total hip arthroplasty. Quantitating its utility and precision. J Arthroplasty 7(Suppl):403–409
Della Valle AG, Padgett DE, Salvati EA (2005) Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg 13(7):455–462
Carter LW, Stovall DO, Young TR (1995) Determination of accuracy of preoperative templating of noncemented femoral prostheses. J Arthroplasty 10(4):507–513
Woolson ST, Hartford JM, Sawyer A (1999) Results of a method of leg-length equalization for patients undergoing primary total hip replacement. J Arthroplasty 14(2):159–164
Crooijmans HJ, Laumen AM, van Pul C, van Mourik JB (2009) A new digital preoperative planning method for total hip arthroplasties. Clin Orthop Relat Res 467(4):909–916
Bertz A, Indrekvam K, Ahmed M, Englund E, Sayed-Noor AS (2012) Validity and reliability of preoperative templating in total hip arthroplasty using a digital templating system. Skeletal Radiol 41(10):1245–1249
Schmidutz F, Steinbrück A, Wanke-Jellinek L, Pietschmann M, Jansson V, Fottner A (2012) The accuracy of digital templating: a comparison of short-stem total hip arthroplasty and conventional total hip arthroplasty. Int Orthop 36(9):1767–1772
Efe T, El Zayat BF, Heyse TJ, Timmesfeld N, Fuchs-Winkelmann S, Schmitt J (2011) Precision of preoperative digital templating in total hip arthroplasty. Acta Orthop Belg 77(5):616–621
Whiddon DR, Bono JV, Lang JE, Smith EL, Salyapongse AK (2011) Accuracy of digital templating in total hip arthroplasty. Am J Orthop (Belle Mead NJ) 40(8):395–398
Brew CJ, Simpson PM, Whitehouse SL, Donnelly W, Crawford RW, Hubble MJ (2012) Scaling digital radiographs for templating in total hip arthroplasty using conventional acetate templates independent of calibration markers. J Arthroplasty 27(4):643–647
Choi JK, Geller JA, Wang W, Nyce JD, Macaulay W (2011) The accuracy and reliability of preoperative templating for metal-on-metal hip resurfacing. J Arthroplasty 26(5):765–770
Steinberg EL, Shasha N, Menahem A, Dekel S (2010) Preoperative planning of total hip replacement using the TraumaCad™ system. Arch Orthop Trauma Surg 130(12):1429–1432
Gamble P, de Beer J, Petruccelli D, Winemaker M (2010) The accuracy of digital templating in uncemented total hip arthroplasty. J Arthroplasty 25(4):529–532
Lecerf G, Fessy MH, Philippot R (2009) Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res 95(3):210–219
Iorio R, Siegel J, Specht LM, Tilzey JF, Hartman A, Healy WL (2009) A comparison of acetate vs digital templating for preoperative planning of total hip arthroplasty. Is digital templating accurate and safe? J Arthroplasty 24(2):175–179
Unnanuntana A, Wagner D, Goodman SB (2009) The accuracy of preoperative templating in cementless total hip arthroplasty. J Arthroplasty 24(2):180–186
Hofmann AA, Bolognesi M, Lahav A, Kurtin S (2008) Minimizing leg-length inequality in total hip arthroplasty: use of preoperative templating and an intraoperative X-ray. Am J Orthop (Belle Mead NJ) 37(1):18–23
Della Valle A, Slullitel G, Piccaluga F, Salvati E (2005) The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty. J Arthroplasty 20(1):51–58
Fottner A, Steinbruck A, Sadoghi P, Mazoochian F, Jansson V (2011) Digital comparison of planned and implanted stem position in total hip replacement using a program form migration analysis. Arch Orthop Trauma Surg 131(7):1013–1019
Jassim SS, Ingham C, Keeling M, Wimhurst JA (2012) Digital templating facilitates accurate leg length correction in total hip arthroplasty. Acta Orthop Belg 78:344–349
Kniesel B, Konstantinidis L, Hirschmüller A, Südkamp N, Helwig P (2014) Digital templating in total knee and hip replacement: an analysis of planning accuracy. Int Orthop 38(4):733–739
Baker RP, Squires B, Gargan MF, Bannister GC (2006) Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial. J Bone Joint Surg Am 88(12):2583–2589
Blomfeldt R, Törnkvist H, Eriksson K, Söderqvist A, Ponzer S, Tidermark J (2007) A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg (Br) 89(2):160–165
Keating JF, Grant A, Masson M, Scott NW, Forbes JF (2006) Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am 88(2):249–260
Macaulay W, Nellans KW, Garvin KL, Iorio R, Healy WL, Rosenwasser MP (2008) Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award. J Arthroplasty 23(6 Suppl 1):2–8
National Institute for Health and Care Excellence (2011) Hip fracture: the management of hip fracture in adults. CG124 (2011). National Institute for Health and Care Excellence, London
Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R (1986) Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty 1(1):21–28
Rubash HE, Parvataneni HK (2007) The pants too short, the leg too long: leg length inequality after THA. Orthopedics 30(9):764–765
Ezzet KA, McCauley JC (2014) Use of intraoperative X-rays to optimize component position and leg length during total hip arthroplasty. J Arthroplasty 29(3):580–585
Conn KS, Clarke MT, Hallett JP (2002) A simple guide to determine the magnification of radiographs and to improve the accuracy of preoperative templating. J Bone Joint Surg (Br) 84(2):269–272
Keršič M, Dolinar D, Antolič V, Mavčič B (2013) The impact of leg length discrepancy on clinical outcome of total hip arthroplasty: comparison of four measurement methods. J Arthroplasty 29(1):137–141
Tsai TY, Dimitriou D, Li G, Kwon YM (2014) Does total hip arthroplasty restore native hip anatomy? Three-dimensional reconstruction analysis. Int Orthop 38(8):1577–1583
Charnley J (1979) Low friction arthroplasty of the hip. Springer Verlag, Berlin, pp 134–139, 246
Sproul RC, Reynolds HM, Lotz JC, Ries MD (2007) Relationship between femoral head size and distance to lesser trochanter. Clin Orthop Relat Res 461(461):122–124
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Lakstein, D., Bachar, I., Debi, R. et al. Radiographic templating of total hip arthroplasty for femoral neck fractures. International Orthopaedics (SICOT) 41, 831–836 (2017). https://doi.org/10.1007/s00264-016-3235-y
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DOI: https://doi.org/10.1007/s00264-016-3235-y