Combining the Advantages of 3-D and 2-D Templating of Total Hip Arthroplasty Using a New Tin-filtered Ultra-low-dose CT of the Hip with Comparable Radiation Dose to Conventional Radiographs

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2022 Dec 2

PMID 36460762

Authors

Dominik Kaiser

Armando Hoch

Stefan Rahm

Christoph Stern

Reto Sutter

Patrick O Zingg

Affiliations

Soon will be listed here.

Abstract

Background: Inaccurately scaled radiographs for total hip arthroplasty (THA) templating are a source of error not recognizable to the surgeon and may lead to inaccurate reconstruction and thus revision surgery or litigation. Planning based on computed tomography (CT) scans is more accurate but associated with higher radiation exposure. The aim of this study was (1) to retrospectively assess the scaling deviation of pelvic radiographs; (2) to prospectively assess the feasibility and the radiation dose of THA templating on radiograph-like images reconstructed from a tin-filtered ultra-low-dose CT dataset.

Methods: 120 consecutive patients were retrospectively analyzed to assess the magnification error of our current THA templates. 27 consecutive patients were prospectively enrolled and a radiographic work-up in the supine position including a new tin-filtered ultra-low-dose CT scan protocol was obtained. THA was templated on both images. Radiation dose was calculated.

Results: Scaling deviations between preoperative radiographs and CT of ≥ 5% were seen in 25% of the 120 retrospectively analyzed patients. Between the two templates trochanter tip distance differed significantly (Δ2.4 mm, 0-7 mm, p = 0.035)), predicted femoral shaft size/cup size was the same in 45%/41%. The radiation dose of the CT (0.58 mSv, range 0.53-0.64) was remarkably low.

Conclusion: Scaling deviations of pelvic radiographs for templating THA may lead to planning errors of ≥ 3 mm in 25% and ≥ 6 mm in 2% of the patients. 2-D templating on radiograph-like images based on tin-filtered ultra-low-dose CT eliminates this source of error without increased radiation dose.

Level Of Evidence: Retrospective and prospective comparative study, Level III.

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References

Ramme A, Fisher N, Egol J, Chang G, Vigdorchik J . Scaling Marker Position Determines the Accuracy of Digital Templating for Total Hip Arthroplasty. HSS J. 2018; 14(1):55-59. PMC: 5786590. DOI: 10.1007/s11420-017-9578-0. View

Young M, Dempsey M, De La Rocha A, Podeszwa D . The cross-table lateral radiograph results in a significantly increased effective radiation dose compared with the Dunn and single frog lateral radiographs. J Pediatr Orthop. 2014; 35(2):157-61. DOI: 10.1097/BPO.0000000000000231. View

Sinclair V, Wilson J, Jain N, Knowles D . Assessment of accuracy of marker ball placement in pre-operative templating for total hip arthroplasty. J Arthroplasty. 2014; 29(8):1658-60. DOI: 10.1016/j.arth.2014.03.013. View

Lecerf G, Fessy M, Philippot R, Massin P, Giraud F, Flecher X . Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res. 2009; 95(3):210-9. DOI: 10.1016/j.otsr.2009.03.010. View

Shi X, Li C, Cheng C, Feng C, Li S, Liu J . Preoperative Planning for Total Hip Arthroplasty for Neglected Developmental Dysplasia of the Hip. Orthop Surg. 2019; 11(3):348-355. PMC: 6595139. DOI: 10.1111/os.12472. View

The B, Verdonschot N, van Horn J, van Ooijen P, Diercks R . Digital versus analogue preoperative planning of total hip arthroplasties: a randomized clinical trial of 210 total hip arthroplasties. J Arthroplasty. 2007; 22(6):866-70. DOI: 10.1016/j.arth.2006.07.013. View

Weber M, Woerner M, Springorum H, Hapfelmeier A, Grifka J, Renkawitz T . Plain radiographs fail to reflect femoral offset in total hip arthroplasty. J Arthroplasty. 2014; 29(8):1661-5. DOI: 10.1016/j.arth.2014.03.023. View

Callanan M, Jarrett B, Bragdon C, Zurakowski D, Rubash H, Freiberg A . The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2010; 469(2):319-29. PMC: 3018230. DOI: 10.1007/s11999-010-1487-1. View

Desai A, Dramis A, Board T . Leg length discrepancy after total hip arthroplasty: a review of literature. Curr Rev Musculoskelet Med. 2013; 6(4):336-41. PMC: 4094096. DOI: 10.1007/s12178-013-9180-0. View

10.

Schwartz Jr J, Mayer J, Engh C . Femoral fracture during non-cemented total hip arthroplasty. J Bone Joint Surg Am. 1989; 71(8):1135-42. View

11.

Clark C, Huddleston H, Schoch 3rd E, Thomas B . Leg-length discrepancy after total hip arthroplasty. J Am Acad Orthop Surg. 2006; 14(1):38-45. DOI: 10.5435/00124635-200601000-00007. View

12.

Mainard D, Barbier O, Knafo Y, Belleville R, Mainard-Simard L, Gross J . Accuracy and reproducibility of preoperative three-dimensional planning for total hip arthroplasty using biplanar low-dose radiographs : A pilot study. Orthop Traumatol Surg Res. 2017; 103(4):531-536. DOI: 10.1016/j.otsr.2017.03.001. View

13.

Geijer M, Rundgren G, Weber L, Flivik G . Effective dose in low-dose CT compared with radiography for templating of total hip arthroplasty. Acta Radiol. 2017; 58(10):1276-1282. DOI: 10.1177/0284185117693462. View

14.

Mazrani W, McHugh K, Marsden P . The radiation burden of radiological investigations. Arch Dis Child. 2007; 92(12):1127-31. PMC: 2066089. DOI: 10.1136/adc.2006.101782. View

15.

Wylie J, Jenkins P, Beckmann J, Peters C, Aoki S, Maak T . Computed Tomography Scans in Patients With Young Adult Hip Pain Carry a Lifetime Risk of Malignancy. Arthroscopy. 2017; 34(1):155-163.e3. DOI: 10.1016/j.arthro.2017.08.235. View

16.

Lechler P, Frink M, Gulati A, Murray D, Renkawitz T, Bucking B . The influence of hip rotation on femoral offset in plain radiographs. Acta Orthop. 2014; 85(4):389-95. PMC: 4105770. DOI: 10.3109/17453674.2014.931196. View

17.

Hofmann A, Skrzynski M . Leg-length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits!. Orthopedics. 2000; 23(9):943-4. DOI: 10.3928/0147-7447-20000901-20. View

18.

Cogan A, Klouche S, Mamoudy P, Sariali E . Total hip arthroplasty dislocation rate following isolated cup revision using Hueter's direct anterior approach on a fracture table. Orthop Traumatol Surg Res. 2011; 97(5):501-5. DOI: 10.1016/j.otsr.2011.04.005. View

19.

Forde B, Engeln K, Bedair H, Bene N, Talmo C, Nandi S . Restoring femoral offset is the most important technical factor in preventing total hip arthroplasty dislocation. J Orthop. 2018; 15(1):131-133. PMC: 5895885. DOI: 10.1016/j.jor.2018.01.026. View

20.

Konyves A, Bannister G . The importance of leg length discrepancy after total hip arthroplasty. J Bone Joint Surg Br. 2005; 87(2):155-7. DOI: 10.1302/0301-620x.87b2.14878. View