Abstract
The use of digital radiography is becoming more prevalent in orthopedics. This transition impacts the ability to preoperatively plan for implants in total hip arthroplasty (THA) and total knee arthroplasty (TKA). This article reports on the clinical success of digital templating using the Advanced Case Plan (Stryker Imaging, Flower Mound, Texas) system in primary THA and TKA.
Digital radiographs of 269 consecutive patients undergoing primary THA (93 cases) or TKA (176 cases) were templated using the Advanced Case Plan digital software package. A 25.4-mm metallic sphere was used as a calibrating marker. Anteroposterior hip and lateral knee radiographs were digitally templated preoperatively and compared to the actual size of the implants at the time of surgery. The accuracy of calibrating images using the metallic sphere was validated by measuring the diameter of femoral heads on 25 postoperative hip radiographs. Digital templating was accurate in predicting the correct implant size in 58.5% of THAs and 66% of TKAs. In 93% of THAs and 98.5% of TKAs, preoperative templating was within 1 size of the final implant. There were no cases in which the predicted implant size varied from the final components by >2 sizes. Calibrating the image using the metallic sphere marker was found to be highly accurate, predicting the correct femoral head size within 1.5 mm in all 25 cases (7 hemiarthroplasties and 18 THAs).
Digital templating is an effective means for predicting the size of THA and TKA components, thus remaining a viable option as we transition into the modern era of digital radiography. Future studies will evaluate interobserver reliability and the impact of level of training on templating accuracy.
- 1.Iorio R, Siegel J, Specht LM, Tilzey JF, Hartman A, Healy WL. A comparison of acetate vs digital templating for preoperative planning of total hip arthroplasty: is digital templating accurate and safe [published online ahead of print March 28, 2008]?J Arthroplasty. 2009; 24(2):175–179.
10.1016/j.arth.2007.11.019 Crossref Medline, Google Scholar - 2.Specht LM, Levitz S, Iorio R, Healy WL, Tilzey JF. A comparison of acetate and digital templating for total knee arthroplasty. Clin Orthop Relat Res. 2007; (464):179–183. Crossref Medline, Google Scholar
- 3.Heal J, Blewitt N. Kinemax total knee arthroplasty: trial by template. J Arthroplasty. 2002; 17(1):90–94.
10.1054/arth.2002.27258 Crossref Medline, Google Scholar - 4.Hossain M, Lewis J, Sinha A. Digital preoperative templating is more accurate in total hip replacement compared to analogue templating. Eur J Orthop Surg Traumatol. 2008; (18):577–580.
10.1007/s00590-008-0356-z Crossref, Google Scholar - 5.Lewis J, Hossain M, Mustafa A, Sinha A. Comparison of digital and plain radiography preoperative templating in total knee arthroplasty. Eur J Orthop Surg Traumatol. 2008; (18):357–360.
10.1007/s00590-008-0313-x Crossref, Google Scholar - 6.The B, Diercks RL, van Ooijen PM, van Horn JR. 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. 2005; 76(1):78–84.
10.1080/00016470510030364 Crossref Medline, Google Scholar - 7.The B, Verdonschot N, van Horn JR, van Ooijen PM, Diercks RL. Digital versus analogue preoperative planning of total hip arthroplasties: a randomized clinical trial of 210 total hip arthroplasties [published online ahead of print March 28, 2007]. J Arthroplasty. 2007; 22(6):866–870.
10.1016/j.arth.2006.07.013 Crossref Medline, Google Scholar - 8.Trickett RW, Hodgson P, Forster MC, Robertson A. The reliability and accuracy of digital templating in total knee replacement. J Bone Joint Surg Br. 2009; 91(7):903–906.
10.1302/0301-620X.91B7.21476 Crossref Medline, Google Scholar - 9.Gamble P, de Beer J, Petruccelli D, Winemaker M. The accuracy of digital templating in uncemented total hip arthroplasty [published online of print June 2, 2009]. J Arthroplasty. 2010; 25(4):529–532.
10.1016/j.arth.2009.04.011 Crossref Medline, Google Scholar - 10.Crooijmans HJ, Laumen AM, van Pul C, van Mourik JB. A new digital preoperative planning method for total hip arthroplasties [published online ahead of print September 10, 2008]. Clin Orthop Relat Res. 2009; 467(4):909–916.
10.1007/s11999-008-0486-y Crossref Medline, Google Scholar - 11.González Della Valle A, Comba F, Taveras N, Salvati EA. The utility and precision of analogue and digital preoperative planning for total hip arthroplasty [published online ahead of print April 3, 2007]. Int Orthop. 2008; 32(3):289–294.
10.1007/s00264-006-0317-2 Crossref Medline, Google Scholar - 12.Del Gaizo D, Soileau ES, Lachiewicz PF. Value of preoperative templating for primary total knee arthroplasty. J Knee Surg. 2009; 22(4):284–293.
10.1055/s-0030-1247765 Crossref Medline, Google Scholar
