Dataset Information

Free Hip Arthroplasty Templating Software - Does it Work?

ABSTRACT:

Background

Preoperative planning is important for successful total hip arthroplasty (THA) and has been historically performed using acetate templates. Digital software templating has been adopted for evaluating implant size, position, and alignment. Commercial software can be expensive, but free programs exist. Detroit Bone Setter (detroitbonesetter.com, Detroit, MI) is a freely available templating program, but hasn't been validated. Our study reports this program's accuracy for templating THA.

Methods

Sixty-five patients undergoing THA between 2017 and 2022 at 2 hospitals were included. All cases were templated by the senior author or orthopaedic trauma fellow prospectively or retrospectively in a blinded fashion. Direct anterior or posterior approaches were used based on attending surgeon's preference. A student's t-test was used to compare means of templated vs actual implant sizes of femoral and acetabular components.

Results

There was no significant difference between implanted (mean [M] = 6.4, standard deviation [SD] = 2.0) and templated femoral component sizes (M = 5.7, SD = 2.1). There was a significant difference between implanted (M = 57.0, SD = 3.9) and templated acetabular component sizes (M = 53.4, SD = 3.0). Bland-Altman testing demonstrated femoral components with positive measurement bias of 0.62, indicating slight overestimation of implant size. Acetabular component size was overestimated with positive measurement bias of 3.6 mm.

Conclusions

Detroit Bone Setter is advantageous as it is freely available and supports most major company implants. It accurately templated femoral component size but consistently overestimated acetabular component size by 3.6 mm. Further studies are needed prior to recommending its routine use for templating THA when other validated methods exist. It could be used with caution when no other methods are available.

SUBMITTER: Jouflas AC

PROVIDER: S-EPMC10498402 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Free Hip Arthroplasty Templating Software - Does it Work?

Jouflas Alex C AC Gilani Syed Furqan SF Nadar Arun C AC Whitaker John J Carlson Jon B JB

Arthroplasty today 20230908

<h4>Background</h4>Preoperative planning is important for successful total hip arthroplasty (THA) and has been historically performed using acetate templates. Digital software templating has been adopted for evaluating implant size, position, and alignment. Commercial software can be expensive, but free programs exist. Detroit Bone Setter (detroitbonesetter.com, Detroit, MI) is a freely available templating program, but hasn't been validated. Our study reports this program's accuracy for templat ...[more]

PMID: 37712074

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Project description:BackgroundDigital templating systems foster patient-specific measurements for preoperative planning.Questions/purposesWe aim (1) to verify the accuracy of a templating system, (2) to describe the effects of scaling marker position on the accuracy of digital templating of the hip, and (3) to provide a practical guide for scaling marker position using patient body mass index (BMI).MethodsA scaling sphere was placed in five positions along the anterior-posterior axis of an acetabular implant and pelvis phantom, and x-rays were obtained. Each radiograph was templated for the acetabular component and recorded. A retrospective review identified CT scans of preoperative hip arthroplasty cases. The center of the greater trochanter was calculated from these CT scans as the percent distance from the anterior thigh and recorded with the patient's BMI.ResultsBy centering the scaling sphere on the acetabular component, an accurate cup size was achieved. A difference of 3.5 cm in sphere placement resulted in a full cup size magnification error. Positioning the scaling sphere at the level of the pubic symphysis resulted in a difference of four cup sizes. This patient population had an average BMI of 28.72 kg/m2 (standard deviation 6.26 kg/m2) and an average position of the center of the greater trochanter of 51% (standard deviation of 6%) from the anterior surface of thigh.ConclusionsDigital templating relies on scaling marker position to accurately estimate implant size. Based on the findings in this study, scaling markers for hip imaging should be placed laterally, mid-thigh in the anterior-posterior direction for patients with a BMI between 25 and 40 kg/m2. If abnormal hip anatomy or extremes of BMI are discovered, then scaling sphere positioning should be optimized on a case-by-case basis. Digital templating systems for total hip arthroplasty must use precisely placed scaling markers at the level of the hip joint to allow for accurate implant size estimation.

Project description:BackgroundSpinopelvic mechanics are critical in total hip arthroplasty; however, there is no established consensus for adjusting acetabular component positioning based on spinopelvic parameters. This study aimed to (1) validate a recently developed Patient-Specific acetabular safe-zone calculator that factors in spinopelvic parameters and (2) compare differences with hip-spine classification targets.MethodsA total of 3750 patients underwent primary total hip arthroplasty across 3 academic referral centers, with 33 (0.88%) requiring revision for instability. Spinopelvic parameters were measured before initial total hip arthroplasty, and acetabular component position was measured following the index and revision procedures. Most operations employed either computer navigation or robotic assistance (94%). Surgical approaches included both anterior and posterior techniques. Utilizing our recently developed patient-specific safe-zone calculator, theoretical intraoperative positions were calculated and compared to true component positions before and after revision.ResultsAmong 33 patients who underwent revision, none dislocated at an average follow-up of 5.1 years. In the external validation cohort, the average absolute differences between the patient-specific safe-zone and the median hip-spine classification recommendation were 3.8° ± 2.1° inclination and 5.0° ± 3.2° version. For the pooled cohort, the absolute differences between the patient-specific safe-zone targets and the prerevision component positions were 7.9° ± 5.1° inclination and 11.4° ± 6.9° version. After revision, the mean absolute differences decreased to 3.6° ± 3.1° inclination and 5.8° ± 3.5° version (P < .001).ConclusionsA patient-specific approach improved acetabular component positioning accuracy within 6° of version and 4° of inclination of stable, revised hips. Patient-specific safe zones provide quantitative targets for nuanced spinopelvic preoperative planning that may mitigate risk of instability and may indicate use of assisted technologies.

Dataset Information

Free Hip Arthroplasty Templating Software - Does it Work?

Background

Methods

Results

Conclusions

Publications

Free Hip Arthroplasty Templating Software - Does it Work?

Similar Datasets

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