Introduction: The aim of the study was to investigate the reproducibility and accuracy of templating total hip arthroplasty with on-screen digital radiographs using three commercially available software packages, and compare the results to templating on-screen using acetates.

Method: In twenty patients undergoing hybrid total hip arthroplasty, pre-operative templating for acetabular size, femoral offset and stem size were performed by three independent observers using on-screen digital radiographs by three different techniques. The magnification of the on-screen images were adjusted appropriately by using a metal coin marker of known size attached to the patient at time of acquiring the radiographs. These images were used to template for total hip arthroplasty using three commercially available digital templating software packages (Orthoview™ Workstation, Southampton, UK, Ferrania LifeWeb TraumaCad™, Berkshire, UK and mdesk™ software suite, RSA Biomedical, Sweden). The templated results were compared with the component sizes subsequently implanted and to templating on-screen using acetates. Intra- and inter-observer reproducibility were assessed using the Intraclass Correlation Coefficient (ICC).

Results: Intra-observer reproducibility was good for the three software systems with almost all ICC values > 0.70. Inter-observer reproducibility was less consistent, which may reflect familiarity and may improve with a “learning curve”. All three software systems tended to slightly undersize the acetabular size.

Discussion: For both reproducibility and accuracy, all the three commercial systems were comparable with templating using the acetate template method. Digital templating using software packages is an acceptable method of templating. Templating software packages are certainly an attractive proposition but until installation & maintenance costs are reduced, “traditional” templating with acetates remains the most effective option.

Recombinant Bone Morphogenetic Protein 7 (OP-1) has been available in the UK since 2001, but there has been little published data on its use in the upper limb. In our institution OP-1 has been used in the management of 23 upper limb patients between 2001–2005, including 10 humeral non-unions. We believe this represents one of the largest single-unit cohorts of humeral fractures treated with OP-1.

We reviewed the 10 humeral patients, who were all tertiary referrals with established non-unions. Two had been treated non-operatively before referral. The remaining eight had undergone a mean of 2.1 operations before OP-1 was used, with autologous bone grafting used in the majority of cases. Surgery occurred at a mean of 70.5 months following initial fracture. Seven patients underwent revision of the fracture fixation, and autologous bone graft was used with the OP-1 in 8 cases. Clinical union was established in 8 patients (80%) within a mean of 7.4 months. Radiological union was achieved in 8 patients (80%) within a mean of 9.1 months. No complications or adverse effects from the use of OP-1 were encountered.

Both cases which failed to unite had a definite history of deep infection prior to index surgery, despite initial treatment with a staged revision procedure before OP-1 use.

This study shows that OP-1 can be used successfully in the treatment of recalcitrant non-unions of the humerus following failure of traditional fracture management methods.