The Impact of Femoral Bone Quality on Total Hip Preoperative Templating

Introduction:
Accurate templating is an integral part of preoperativeplanning for total hip arthroplasty (THA). Templating accuracy of cementless implants did not match the accuracy of cemented designs. The aim of this study was to assess the impact of Dorr femoral classification on the accuracy of preoperative digital templating.

Patients and Methods:
This was a retrospective study of cementless total hip arthroplasties preoperative planning using one implant design. All cases were analyzed and reviewed by an orthopedic resident and a fellowship trained arthroplasty surgeon. Each x-ray was evaluated and assigned a femoral Dorr classification. Accuracy of templating was determined by comparing the templated size with the actual implant size both for the femoral and acetabular components.

Results:
A total of 102 cementless THAs using one implant combination were reviewed. Exact templating size was achieved in 35.3% for the acetabulum, 25.5% for the femur and only in 9.8% for both components. Reasonable templating ± 1 of the actual size was achieved in 78.4% for the acetabulum, 74.5% for the femur and 60.8% for both components. Use of Dorr femoral type classification did not result in better templating accuracy.

Conclusion:
Preoperative hip cementless templating using digital x-rays with double marker method do not improve accuracy. Accounting for bone quality using the Dorr femoral classification did not improve accuracy.