Computed tomography for preoperative planning in total hip arthroplasty: what radiologists need to know


The number of total hip arthroplasties is continuously rising. Although less invasive surgical techniques, sophisticated component design, and intraoperative navigation techniques have been introduced, the rate of peri- and postoperative complications, including dislocations, fractures, nerve palsies, and infections, is still a major clinical problem. Better patient outcome, faster recovery and rehabilitation, and shorter operation times therefore remain to be accomplished. A promising strategy is to use minimally invasive techniques in conjunction with modular implants, aimed at independently reconstructing femoral offset and leg length on the basis of highly accurate preoperative planning. Plain radiographs have clear limitations for the correct estimation of hip joint geometry and bone quality. Three-dimensional assessment based on computed tomography (CT) allows optimizing the choice and positions of implants and anticipating difficulties to be encountered during surgery. Postoperative CT is used to monitor operative translation and plays a role in arthroplastic quality management. Radiologists should be familiar with the needs of orthopedic surgeons in terms of CT acquisition, post-processing, and data transfer. The CT protocol should be optimized to enhance image quality and reduce radiation exposure. When dedicated orthopedic CT protocols and state-of-the-art scanner hardware are used, radiation exposure can be decreased to a level just marginally higher than that of conventional preoperative radiography. Surgeons and radiologists should use similar terminology to avoid misunderstanding and inaccuracies in the transfer of preoperative planning.

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Conflict of interest

Alexander Huppertz has been a full time paid employee of Siemens AG since 1 June 2004. He is Associate Director of the Imaging Science Institute Charité. The Institute is a scientific cooperation between the Charité, University Hospitals of Berlin, Germany and Siemens Healthcare in the form of a private–public partnership (PPP). Sebastian Radmer and Martin Sparmann received speakers’ honoraria for specific speeches from Symbios Orthopédie SA, Switzerland.

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Correspondence to Alexander Huppertz.

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Huppertz, A., Radmer, S., Wagner, M. et al. Computed tomography for preoperative planning in total hip arthroplasty: what radiologists need to know. Skeletal Radiol 43, 1041–1051 (2014).

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  • Computed tomography
  • Total hip arthroplasty
  • 3D post-processing
  • Radiation exposure
  • Hip measurements
  • Modular endoprosthesis
  • Minimally invasive surgery