Precision and accuracy of pre-surgical planning of non-cemented total hip replacement with calibrated digital images and acetates

J Orthop Surg Res. 2021 Jul 3;16(1):431. doi: 10.1186/s13018-021-02584-2.


Background: When approaching a joint replacement procedure, pre-surgical planning is essential to predict an accurate estimation of implant size and position. There are currently two methods to achieve it, analog and digital. The present study aims to demonstrate how the hybrid technique is accurate and precise for pre-surgical planning in a non-cemented total hip replacement.

Methods: Concordance-type study is used against a gold standard, as well as inter- and intra-observer consistency evaluation of two orthopedic surgeons and two orthopedic surgery residents. Accuracy was calculated with the intra-class correlation coefficient (ICC). Afterwards, the same calculation was done considering a margin of error with one size more and one less.

Results: Thirty-eight patients were included in the study: 19 women and 19 men. Twenty-two prostheses (57.89%) were right-sided and 16 were left (42.11%). Twelve prostheses (31.57%) were Stryker and 26 Johnson & Johnson (68.43%). Acetabular cup correlation compared with the gold standard was moderate: ICC reported 0.45 (95% CI, 0.15-0.76). When adjusted by ± 1 size, ICC was 0.48 (95% CI, 0.18-0.79). On the other hand, results from the femoral stem reported ICC 0.85 (95% CI, 0.07-0.98). When adjusted by ± 1 size, ICC was 0.86 (95% CI, 0.06-0.99).

Conclusions: Hybrid templating is a reliable substitute for analog or digital planning. It is quick, inexpensive, accurate, and better results are observed in the femoral component regardless the level of expertise of the evaluator.

Level of evidence: Grade IV.

Keywords: Analog templating; Digital templating; Preoperative planning; Reliability; Total hip arthroplasty; Total hip replacement.

MeSH terms

  • Acetabulum / surgery
  • Acetates
  • Arthroplasty, Replacement, Hip*
  • Female
  • Femur / surgery
  • Hip Prosthesis*
  • Humans
  • Image Processing, Computer-Assisted / methods*
  • Male
  • Observer Variation
  • Osteoarthritis, Hip / surgery
  • Patient-Specific Modeling
  • Planning Techniques
  • Precision Medicine / methods*
  • Preoperative Care / methods*
  • Prosthesis Design / methods*
  • Reproducibility of Results
  • Retrospective Studies


  • Acetates