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

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

A Correction to this article was published on 05 September 2020

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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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Change history

  • 05 September 2020

    The original version of this article unfortunately contained a mistake. The spelling of the Geert Pagenstert name was incorrect.

References

  1. Schmalzried TP (2005) Preoperative templating and biomechanics in total hip arthroplasty. Orthopedics 28(8 Suppl):s849–s851

    Article  Google Scholar 

  2. Della Valle AG, Slullitel G, Piccaluga F, Salvati EA (2005) The precision and usefulness of preoperative planning for cemented and hybrid primary total hip arthroplasty. J Arthroplast 20(1):51–58. https://doi.org/10.1016/j.arth.2004.04.016

    Article  Google Scholar 

  3. Della Valle AG, Padgett DE, Salvati EA (2005) Preoperative planning for primary total hip arthroplasty. J Am Acad Orthop Surg 13(7):455–462

    Article  Google Scholar 

  4. Jolles BM, Zangger P, Leyvraz PF (2002) Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplast 17(3):282–288

    Article  CAS  Google Scholar 

  5. Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stockl B (2005) Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br 87(6):762–769. https://doi.org/10.1302/0301-620X.87B6.14745

    Article  CAS  PubMed  Google Scholar 

  6. Petretta R, Strelzow J, Ohly NE, Misur P, Masri BA (2015) Acetate templating on digital images is more accurate than computer-based templating for total hip arthroplasty. Clin Orthop Relat Res 473(12):3752–3759. https://doi.org/10.1007/s11999-015-4321-y

    Article  PubMed  PubMed Central  Google Scholar 

  7. Asayama I, Chamnongkich S, Simpson KJ, Kinsey TL, Mahoney OM (2005) Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplast 20(4):414–420. https://doi.org/10.1016/j.arth.2004.01.016

    Article  Google Scholar 

  8. Sakalkale DP, Sharkey PF, Eng K, Hozack WJ, Rothman RH (2001) Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res 388:125–134

    Article  Google Scholar 

  9. Liebs TR, Nasser L, Herzberg W, Ruther W, Hassenpflug J (2014) The influence of femoral offset on health-related quality of life after total hip replacement. Bone Joint J 96-B(1):36–42. https://doi.org/10.1302/0301-620x.96b1.31530

    Article  CAS  PubMed  Google Scholar 

  10. Cassidy KA, Noticewala MS, Macaulay W, Lee JH, Geller JA (2012) Effect of femoral offset on pain and function after total hip arthroplasty. J Arthroplast 27(10):1863–1869. https://doi.org/10.1016/j.arth.2012.05.001

    Article  Google Scholar 

  11. Fottner A, Woiczinski M, Kistler M, Schroder C, Schmidutz TF, Jansson V, Schmidutz F (2017) Influence of undersized cementless hip stems on primary stability and strain distribution. Arch Orthop Trauma Surg 137(10):1435–1441. https://doi.org/10.1007/s00402-017-2784-x

    Article  PubMed  Google Scholar 

  12. Rudiger HA, Guillemin M, Latypova A, Terrier A (2017) Effect of changes of femoral offset on abductor and joint reaction forces in total hip arthroplasty. Arch Orthop Trauma Surg 137(11):1579–1585. https://doi.org/10.1007/s00402-017-2788-6

    Article  PubMed  Google Scholar 

  13. 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

    Article  CAS  Google Scholar 

  14. Sinclair VF, Wilson J, Jain NP, Knowles D (2014) Assessment of accuracy of marker ball placement in pre-operative templating for total hip arthroplasty. J Arthroplast 29(8):1658–1660. https://doi.org/10.1016/j.arth.2014.03.013

    Article  Google Scholar 

  15. Eggli S, Pisan M, Muller ME (1998) The value of preoperative planning for total hip arthroplasty. J Bone Joint Surg Br 80(3):382–390

    Article  CAS  Google Scholar 

  16. Knight JL, Atwater RD (1992) Preoperative planning for total hip arthroplasty. Quantitating its utility and precision. J Arthroplast 7 Suppl:403–409

    Article  CAS  Google Scholar 

  17. Lechler P, Frink M, Gulati A, Murray D, Renkawitz T, Bucking B, Ruchholtz S, Boese CK (2014) The influence of hip rotation on femoral offset in plain radiographs. Acta Orthop 85(4):389–395. https://doi.org/10.3109/17453674.2014.931196

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kay RM, Jaki KA, Skaggs DL (2000) The effect of femoral rotation on the projected femoral neck-shaft angle. J Pediatr Orthop 20(6):736–739

    Article  CAS  Google Scholar 

  19. Olsen M, Davis ET, Gallie PA, Waddell JP, Schemitsch EH (2009) The reliability of radiographic assessment of femoral neck-shaft and implant angulation in hip resurfacing arthroplasty. J Arthroplast 24(3):333–340. https://doi.org/10.1016/j.arth.2008.01.304

    Article  Google Scholar 

  20. Kumar PG, Kirmani SJ, Humberg H, Kavarthapu V, Li P (2009) Reproducibility and accuracy of templating uncemented THA with digital radiographic and digital TraumaCad templating software. Orthopedics 32(11):815. https://doi.org/10.3928/01477447-20090922-08

    Article  PubMed  Google Scholar 

  21. 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. Skelet Radiol 41(10):1245–1249. https://doi.org/10.1007/s00256-012-1431-4

    Article  Google Scholar 

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

    Article  Google Scholar 

  23. 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. https://doi.org/10.1007/s11999-008-0486-y

    Article  PubMed  Google Scholar 

  24. Gamble P, de Beer J, Petruccelli D, Winemaker M (2010) The accuracy of digital templating in uncemented total hip arthroplasty. J Arthroplast 25(4):529–532. https://doi.org/10.1016/j.arth.2009.04.011

    Article  Google Scholar 

  25. Della Valle AG, Comba F, Taveras N, Salvati EA (2008) The utility and precision of analogue and digital preoperative planning for total hip arthroplasty. Int Orthop 32(3):289–294. https://doi.org/10.1007/s00264-006-0317-2

    Article  Google Scholar 

  26. 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 Arthroplast 24(2):175–179. https://doi.org/10.1016/j.arth.2007.11.019

    Article  Google Scholar 

  27. Kosashvili Y, Shasha N, Olschewski E, Safir O, White L, Gross A, Backstein D (2009) Digital versus conventional templating techniques in preoperative planning for total hip arthroplasty. Can J Surg 52(1):6–11

    PubMed  PubMed Central  Google Scholar 

  28. The B, Diercks RL, van Ooijen PM, van Horn JR (2005) 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 76(1):78–84. https://doi.org/10.1080/00016470510030364

    Article  PubMed  Google Scholar 

  29. Sariali E, Mouttet A, Pasquier G, Durante E, Catone Y (2009) Accuracy of reconstruction of the hip using computerised three-dimensional pre-operative planning and a cementless modular neck. J Bone Joint Surg Br 91(3):333–340. https://doi.org/10.1302/0301-620X.91B3.21390

    Article  CAS  PubMed  Google Scholar 

  30. Sugano N, Ohzono K, Nishii T, Haraguchi K, Sakai T, Ochi T (1998) Computed-tomography-based computer preoperative planning for total hip arthroplasty. Comput Aided Surg 3(6):320–324. https://doi.org/10.1002/(SICI)1097-0150(1998)3:6%3c320:AID-IGS6%3e3.0.CO;2-O

    Article  CAS  PubMed  Google Scholar 

  31. Pasquier G, Ducharne G, Ali ES, Giraud F, Mouttet A, Durante E (2010) Total hip arthroplasty offset measurement: is CT scan the most accurate option? Orthop Traumatol Surg Res 96(4):367–375. https://doi.org/10.1016/j.otsr.2010.02.006

    Article  CAS  PubMed  Google Scholar 

  32. Inoue D, Kabata T, Maeda T, Kajino Y, Fujita K, Hasegawa K, Yamamoto T, Tsuchiya H (2015) Value of computed tomography-based three-dimensional surgical preoperative planning software in total hip arthroplasty with developmental dysplasia of the hip. J Orthop Sci 20(2):340–346. https://doi.org/10.1007/s00776-014-0683-3

    Article  PubMed  Google Scholar 

  33. Zeng Y, Lai OJ, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX, Zhou X (2014) Three-dimensional computerized preoperative planning of total hip arthroplasty with high-riding dislocation developmental dysplasia of the hip. Orthop Surg 6(2):95–102. https://doi.org/10.1111/os.12099

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hassani H, Cherix S, Ek ET, Rudiger HA (2014) Comparisons of preoperative three-dimensional planning and surgical reconstruction in primary cementless total hip arthroplasty. J Arthroplast 29(6):1273–1277. https://doi.org/10.1016/j.arth.2013.12.033

    Article  Google Scholar 

  35. Sariali E, Mauprivez R, Khiami F, Pascal-Mousselard H, Catonne Y (2012) Accuracy of the preoperative planning for cementless total hip arthroplasty. A randomised comparison between three-dimensional computerised planning and conventional templating. Orthop Traumatol Surg Res 98(2):151–158. https://doi.org/10.1016/j.otsr.2011.09.023

    Article  CAS  PubMed  Google Scholar 

  36. Kase M, O’Loughlin PF, Ait-Si-Selmi T, Pagenstert G, Langlois J, Bothorel H, Bonnin MP (2019) Pre-operative templating in THA. Part I: a classification of architectural hip deformities. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-019-03298-1

    Article  PubMed  Google Scholar 

  37. Bonnin MP, Neto CC, Aitsiselmi T, Murphy CG, Bossard N, Roche S (2015) Increased incidence of femoral fractures in small femurs and women undergoing uncemented total hip arthroplasty—why? Bone Joint J 97-B(6):741–748. https://doi.org/10.1302/0301-620x.97b6.35022

    Article  CAS  PubMed  Google Scholar 

  38. Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE (2012) Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int 22(4):371–378. https://doi.org/10.5301/HIP.2012.9350

    Article  PubMed  Google Scholar 

  39. Meermans G, Doorn JV, Kats JJ (2016) Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique. Bone Joint J 98-B(12):1597–1603. https://doi.org/10.1302/0301-620x.98b12.bjj-2016-0345.r1

    Article  CAS  PubMed  Google Scholar 

  40. Archbold HA, Mockford B, Molloy D, McConway J, Ogonda L, Beverland D (2006) The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability. J Bone Joint Surg Br 88(7):883–886. https://doi.org/10.1302/0301-620X.88B7.17577

    Article  CAS  PubMed  Google Scholar 

  41. Young S (2011) A practical approach based on 25 years of experience. In: Vidalain JP, Ait Si Selmi T, Beverland D et al (eds) The CORAIL® Hip System, 1st edn. Springer, Berlin, pp 52–88. https://doi.org/10.1007/978-3-642-18396-6

  42. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  CAS  Google Scholar 

  43. Cicchetti D (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6(4):284–290

    Article  Google Scholar 

  44. Bendaya S, Anglin C, Lazennec JY, Allena R, Thoumie P, Skalli W (2016) Good vs poor results after total hip arthroplasty: an analysis method using implant and anatomic parameters with the EOS imaging system. J Arthroplast 31(9):2043–2052. https://doi.org/10.1016/j.arth.2015.12.036

    Article  Google Scholar 

  45. Huppertz A, Lembcke A, el Sariali H, Durmus T, Schwenke C, Hamm B, Sparmann M, Baur AD (2015) Low dose computed tomography for 3D planning of total hip arthroplasty: evaluation of radiation exposure and image quality. J Comput Assist Tomogr 39(5):649–656. https://doi.org/10.1097/RCT.0000000000000271

    Article  PubMed  Google Scholar 

  46. Khanuja HS, Vakil JJ, Goddard MS, Mont MA (2011) Cementless femoral fixation in total hip arthroplasty. J Bone Joint Surg Am 93(5):500–509. https://doi.org/10.2106/JBJS.J.00774

    Article  PubMed  Google Scholar 

  47. Murphy CG, Bonnin MP, Desbiolles AH, Carrillon Y, Asmall yi USST (2016) Varus will have varus; a radiological study to assess and predict varus stem placement in uncemented femoral stems. Hip Int 26(6):554–560. https://doi.org/10.5301/hipint.5000412

    Article  PubMed  Google Scholar 

  48. Mainard D, Barbier O, Knafo Y, Belleville R, Mainard-Simard L, Gross JB (2017) Accuracy and reproducibility of preoperative three-dimensional planning for total hip arthroplasty using biplanar low-dose radiographs: a pilot study. Orthop Traumatol Surg Res 103(4):531–536. https://doi.org/10.1016/j.otsr.2017.03.001

    Article  CAS  PubMed  Google Scholar 

  49. Kniesel B, Konstantinidis L, Hirschmuller A, Sudkamp N, Helwig P (2014) Digital templating in total knee and hip replacement: an analysis of planning accuracy. Int Orthop 38(4):733–739. https://doi.org/10.1007/s00264-013-2157-1

    Article  PubMed  Google Scholar 

  50. Bonnin MP, Archbold PH, Basiglini L, Selmi TA, Beverland DE (2011) Should the acetabular cup be medialised in total hip arthroplasty. Hip Int 21(4):428–435. https://doi.org/10.5301/HIP.2011.8582

    Article  PubMed  Google Scholar 

  51. Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br 54(1):61–76

    Article  CAS  Google Scholar 

  52. Bjarnason JA, Reikeras O (2015) Changes of center of rotation and femoral offset in total hip arthroplasty. Ann Transl Med 3(22):355. https://doi.org/10.3978/j.issn.2305-5839.2015.12.37

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Abolghasemian M, Samiezadeh S, Jafari D, Bougherara H, Gross AE, Ghazavi MT (2013) Displacement of the hip center of rotation after arthroplasty of Crowe III and IV dysplasia: a radiological and biomechanical study. J Arthroplast 28(6):1031–1035. https://doi.org/10.1016/j.arth.2012.07.042

    Article  Google Scholar 

  54. Baghdadi YM, Larson AN, Sierra RJ (2013) Restoration of the hip center during THA performed for protrusio acetabuli is associated with better implant survival. Clin Orthop Relat Res 471(10):3251–3259. https://doi.org/10.1007/s11999-013-3072-x

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors are grateful to Mr. Mo Saffarini for his assistance with manuscript preparation and illustrations.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan

    Hideo Kobayashi

  2. Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France

    Alexandre Cech, Yannick Carrillon, Padhraig F. O’Loughlin, Tarik Aït-Si-Selmi & Michel P. Bonnin

  3. Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Setagayaku, Tokyo, Japan

    Masanori Kase

  4. Department of Clinical Research, University of Basel, Basel, Switzerland

    Geert Pagenstart

  5. Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland

    Geert Pagenstart

  6. Knee Institute Basel, Basel, Switzerland

    Geert Pagenstart

  7. Cork University Hospital, South Infirmary, Victoria University Hospital, Mater Private Cork, Cork, Ireland

    Padhraig F. O’Loughlin

  8. ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland

    Hugo Bothorel

  9. Artro Institute, Lyon, France

    Tarik Aït-Si-Selmi & Michel P. Bonnin

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  1. Hideo Kobayashi
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Correspondence to Hugo Bothorel.

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Conflict of interest

Authors HK, AC, MK, YC, PFOL and HB declare that they have no conflict of interest. TASS receives royalties and or consulting fees from DePuy-Synthes, Symbios, and Corin-Tornier. MPB receives royalties and or consulting fees from DePuy-Synthes, Symbios, Corin-Tornier, Wright-Tornier, and Integra.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board (IRB) who approved this study in advance (COS-RGDS-2019-05-004-BONNIN-M) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kobayashi, H., Cech, A., Kase, M. et al. Pre-operative templating in THA. Part II: a CT-based strategy to correct architectural hip deformities. Arch Orthop Trauma Surg 140, 551–562 (2020). https://doi.org/10.1007/s00402-020-03341-6

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