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General Orthopaedics


The International Society for Technology in Arthroplasty (ISTA), 27th Annual Congress. PART 1.



Digital templating is a critical part of preoperative planning for total hip arthroplasty (THA) that is increasingly used by orthopaedic surgeons as part of their preoperative planning process. Digital templating has been used as a method of reducing hospital costs by eliminating the need for acetate films and providing an accurate method of preoperative planning. Pre-operative templating can help anticipate and predict appropriate component sizes to help avoid postoperative leg length discrepancy, failure to restore offset, femoral fracture, and instability. A preoperative plan using digital radiographs for surgical templating for component size can improve intraoperative accuracy and precision. While templating on conventional and digital radiographs is reliable and accurate, the accuracy of templating on digital images acquired with a novel biplanar imaging system (EOS Imaging Inc, Cambridge, MA, USA) remains unknown. EOS imaging captures whole body images of a standing patient without stitching or vertical distortion, less magnification error and exposes patients to less radiation than a pelvis AP radiograph. Therefore, the purpose of this study was to compare EOS imaging and conventional anteroposterior (AP) xrays for preoperative digital templating for THA, and compare the results to the implant sizes used intraoperatively.


Forty primary unilateral THA patients had preoperative supine AP xrays and standing EOS imaging. The mean age for patients was 61 ± 8 years, the mean body mass index 29 ± 6 kg/m2 and 21 patients were female. All patients underwent a THA with the same THA system (R3 Acetabular System and Synergy Cementless Stem, Smith & Nephew, TN, USA) by a single surgeon. Two blinded observers preoperatively templated using both AP xray and EOS imaging for each patient to predict acetabular size, femoral component size, and stem offset. All templating was performed by two observers with standard software (Ortho Toolbox, Sectra AB, Linköping, Sweden) [Figure 1] one week prior to surgery, and were compared using the Cronbach's alpha (∝) coefficient of reliability. The accuracy of templating was reported as the average percent agreement between the implanted size and the templated size for each component.


For templating acetabular component size, the exact size was predicted for 48% using AP xrays and 70% using EOS imaging, and within 1 size for 88% using xrays and 98% using EOS imaging. For templating femoral component size, the exact size was predicted exactly for 33% using AP xrays and 60% using EOS imaging, and within 1 size for 85% using xrays and 98% using EOS imaging (Figure 2). Interobserver agreement was excellent for acetabular components (Cronbach's α = 0.94) and femoral components (Cronbach's α = 0.96) using EOS imaging.


This study demonstrates that preoperative digital templating for THA using EOS imaging is accurate, with excellent interobserver agreement. EOS imaging has less magnification error, which may partially explain the accuracy of our templating method.