‘Standard pelvic radiographs’ are generally centred on the sacrum. The target of our review is to refresh the historical principles of total hip arthroplasty planning and then to describe whether and how technology may improve templating accuracy and reproducibility. New technologies provide innovative techniques that allow a more accurate and consistent surgical planning. In the past the most common approach was the use of acetate on printed radiograph films, despite several problems of reproducibility. Preoperative planning allows prediction of the optimal implant position and size and potential difficulties before the surgery. When there is a difference between the actual and functional limb length, pelvic obliquity may be evaluated by comparing the level of both hemi pelvises with patient standing and sitting. Both the actual and functional limb-length discrepancies must be established. Clinical preoperative examinations must also assess the patient’s gait, hip range of motion, ipsilateral knee status, lumbosacral spine and fixed or functional deformities. The patient’s age, sex, preoperative diagnosis, mental status, level of activity, medical history and current medical status, expectations from the surgery and life expectancy should be considered in order to choose implant fixation, implant design and surgical approaches. A common mistake is to believe that planning and templating are equivalent steps, simply aiming at guessing the size of the acetabular and femoral hip components before surgery.
#Hip replacement xray full#
The main goal of surgery is full restoration of the original biomechanical setting of the hip affected by osteoarthritis and represents a key step to achieve a complete functional recovery. The evolution of hip replacements has increased patients’ expectations in terms of function and longevity. Spine–hip relations in osteoarthritic patients undergoing hip joint replacement must be considered.Ĭite this article: EFORT Open Rev 2019 4:626-632. The transverse acetabular ligament (TAL) is a reliable intraoperative soft tissue reference to set cup position. There is no evidence in the few recently published studies that 3D templating impacts positively on clinical outcomes except in difficult cases. Based on these parameters, acetate templating should not be abandoned digital templating allows a permanent record of planning and can be electronically viewed by different members of surgical team 3D templating is intrinsically more accurate. Time efficiency, costs, reproducibility and accuracy must be considered when comparing different templating methods. Limb or pelvis malpositioning during the review results in mislead planning.Ĭorrect templating is possible using three different methods: acetate templating on digital X-ray, digital 2D templating on digital X-ray and 3D digital templating on CT scan. The radiographic review is the first and fundamental step in the planning. Preoperative planning is mandatory to achieve the restoration of a correct and personalized biomechanics of the hip.
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