Comparison of analog and digital preoperative planning in total hip and knee arthroplasties. A prospective study of 173 hips and 65 total knees.
BACKGROUND
Digital correction of the magnification factor is expected to yield more accurate and reliable preoperative plans. We hypothesized that digital templating would be more accurate than manual templating for total hip and knee arthroplasties.


METHODS
Firstly, we established the interobserver and intraobserver reliability of the templating procedure. The accuracy and reliability of digital and analog plans were measured in a series of 238 interventions, which were all planned using both techniques.


RESULTS
Interobserver reliability was good for the planning of knee arthroplasties (e-values 0.63-0.75), but not more than moderate for the planning of hip arthroplasties (e-values 0.22-0.54). Analog plans of knee arthroplasties systematically underestimated the component sizes (1.1 size on average), while the digital procedure proved to be accurate (0.1-0.4 size too small on average). The following figures show percentage of cases receiving a correct implant, allowing an error of one size. Digital templating of the hip arthroplasty was less frequently correct (cemented cup and stem: 72% and 79%; uncemented cup and stem: 52% and 66%) than analog planning (cemented cup and stem: 73% and 89%; uncemented cup and stem: 64% and 52%).


CONCLUSIONS
Planning of component sizes for total knee arthroplasties is an accurate procedure when performed digitally. Our digital preoperative plans which were performed by someone other than the surgeon were less accurate than the analog plans prepared by the surgeon.
The
Bertram
B
Department of Orthopaedic Surgery, Groningen University Hospital, Hanzeplein 1, NL-9700 RB Groningen, The Netherlands. b.the@orth.azg.nl
Diercks
Ron L
RL
van Ooijen
Peter M A
PM
van Horn
Jim R
JR
D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D015588:Observer Variation; D010347:Patient Care Planning; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*