Hip Int ( 2010 ; : 01) 14 -17 20
© 2010 Wichtig Editore - ISSN 1120-7000
14 14
ORIGINAL ARTICLE
INTRODUCTION
The aim of hip arthroplasty is to optimize function and to
restore leg length and femoral offset. As hip anatomy is
highly variable, a careful assessment of leg length and
femoral head offset is needed to reproduce normal hip
biomechanics. Leg length discrepancy following total hip
arthroplasty is a significant source of patient dissatisfac-
tion (1). Therefore preoperative planning for total hip ar-
throplasty is essential for a successful outcome (2). Digital
images using PACS (Picture archiving and communication
system) have replaced standard printed films for templat-
ing in the UK. Various software packages are employed
(3, 4). Digital templating is a method of determining the
size and positioning of the prosthesis within the bone to
optimise function of the joint. It provides a permanent, ar-
chived record of the templating process.
Bone conservation makes hip resurfacing an attractive
conservative option in the treatment of end-stage arthritis
of the hip in young and active patients. The advantages
of Birmingham hip resurfacing (BHR) over Total hip re-
placement (THA) may result from an increased safe range
of movement because of the larger femoral head and en-
hanced stability (5). A recent study by Loughhead et al
showed that resurfacing does not significantly alter leg
length or offset (6). One of the factors which influences the
success of BHR is the use of the optimum implant size.
The aim of our study was to determine the usefulness of
preoperative digital templating in estimating implant sizes
in Birmingham hip resurfacing.
Preoperative digital templating of Birmingham hip
resurfacing
Sujith Konan, Faizal Rayan, Geert Meermans, Jan Geurts, Fares S. Haddad
Department of Trauma and Orthopaedics, University College Hospital, London - UK
ABSTRACT. The aim of our study was to determine the usefulness of preoperative digital templating
of Birmingham hip resurfacing (BHR). This prospective cohort of 30 consecutive Birmingham hip
resurfacings was templated digitally by two senior hip arthroplasty fellows (GM, JG) independently. A
blinded observer then collated information on the actual implant sizes intraoperatively and used this to
statistically analyse the correlation (Interclass correlation coefficient) between the digitally templated
implant sizes and the actual implant sizes used. A significantly high rate of coincidence between digi-
tally templated estimates and the actual implant sizes was noted for both groups of templates. The In-
tra class correlation coefficient (ICC) for the acetabular cup in the two groups were 0.798, p=0.013 and
0.870, p=0.0001. For the femoral component, the ICC values in the two groups were 0.888, p=0.005
and 0.784, p=0.003. Similarly a high reliability of digital templating was noted for both acetabular
(0.823, 0.888) and femoral components (0.777, 0.8132). In conclusion, digital templating can reliably
estimate implant sizes in Birmingham hip resurfacing.
KEY WORDS. Birmingham hip resurfacing, Digital templating, Preoperative planning
Accepted: July 16, 2009