title: Computed tomography for preoperative planning in total hip arthroplasty: what radiologists need to know.
abstract: The number of total hip arthroplasties is continuously rising. Although less invasive surgical techniques, sophisticated component design, and intraoperative navigation techniques have been introduced, the rate of peri- and postoperative complications, including dislocations, fractures, nerve palsies, and infections, is still a major clinical problem. Better patient outcome, faster recovery and rehabilitation, and shorter operation times therefore remain to be accomplished. A promising strategy is to use minimally invasive techniques in conjunction with modular implants, aimed at independently reconstructing femoral offset and leg length on the basis of highly accurate preoperative planning. Plain radiographs have clear limitations for the correct estimation of hip joint geometry and bone quality. Three-dimensional assessment based on computed tomography (CT) allows optimizing the choice and positions of implants and anticipating difficulties to be encountered during surgery. Postoperative CT is used to monitor operative translation and plays a role in arthroplastic quality management. Radiologists should be familiar with the needs of orthopedic surgeons in terms of CT acquisition, post-processing, and data transfer. The CT protocol should be optimized to enhance image quality and reduce radiation exposure. When dedicated orthopedic CT protocols and state-of-the-art scanner hardware are used, radiation exposure can be decreased to a level just marginally higher than that of conventional preoperative radiography. Surgeons and radiologists should use similar terminology to avoid misunderstanding and inaccuracies in the transfer of preoperative planning.
authors.affiliation: Department of Radiology, Charité-University Hospitals Berlin, Charitéplatz 1, 10117, Berlin, Germany, Alexander.Huppertz@charite.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Huppertz
authors.forename: Sebastian
authors.initials: S
authors.lastname: Radmer
authors.forename: Moritz
authors.initials: M
authors.lastname: Wagner
authors.forename: Torsten
authors.initials: T
authors.lastname: Roessler
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Martin
authors.initials: M
authors.lastname: Sparmann
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D006621:Hip Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*