DIGITAL TEMPLATING IN TOTAL HIP ARTHROPLASTY IN THE NHS: ‘COMPUTER SAYS NO…’

Abstract

Introduction: Preoperative planning plays an important role in any surgical procedure and total hip replacement (THR) is no exception. Templating of radiographs allows preoperative assessment of the correct size of implant to be used, lowers the risk of periprosthetic fracture, helps restore femoral offset and leg length, facilitates the optimisation of alignment and ensures the correct implants sizes are available.

With the wide scale use of Picture Archiving and Communication Systems (PACS) in the National Health Service (NHS), the potential exists for faster and more accurate templating of THRs.

Aim: In performing this study, we assessed whether there is adequate provision of the current NHS PACS to allow optimal digital templating for THRs. We also made comparison between the availability and overall ease of conventional versus digital templating.

Methods: Data was collected using a telephone questionnaire requesting information from the on-call orthopaedic Specialist Registrar (SpR) in 28 Greater London and surrounding area NHS Hospitals. Data on the availability of PACS and the ability to template using hard-copy or digital templating was collected and analysed.

Results: PACS were used in all 28 (100%) hospitals that were contacted. None performed conventional templating regularly and only 8 (28.6%) admitted to occasional templating. The predominant reason for this was difficulty in obtaining hard copies of x-rays in 12 (42.9%) hospitals, as well as lack of availability acetate templates, with 13 (46.4%) claiming that this was the case.

Digital templating software was available in 14 (50%) hospitals. Despite this, none of them performed digital templating regularly. In the 50% that did have digital templating, this was not routinely done for the following reasons:

1. only 3 (10.7%) allowed easy access to the software to the SpRs

2. only one SpR received formal training on how to use the system

3. only one hospital regularly used Methods: to accurately allow the software to assess magnification for accurate sizing (e.g. sizing balls)

Discussion: Digital PACS systems have made great improvement in the access of radiographs in the NHS. With regards to orthopaedic practice, however, we have shown that the benefit of digital templating is being overlooked within the NHS.