A Standardised Protocol for Pre-operative Pelvic Radiographs for Templating in Total Hip Arthroplasty

Abdus S Wasim; Muaaz Tahir; Ali Ridha; Amil Sinha; Shakir Hussain

doi:10.7759/cureus.50687

A Standardised Protocol for Pre-operative Pelvic Radiographs for Templating in Total Hip Arthroplasty

Cureus. 2023 Dec 17;15(12):e50687. doi: 10.7759/cureus.50687. eCollection 2023 Dec.

Authors

Abdus S Wasim¹, Muaaz Tahir², Ali Ridha¹, Amil Sinha¹, Shakir Hussain³

Affiliations

¹ Orthopaedics and Trauma, Sandwell and West Birmingham NHS Trust, Birmingham, GBR.
² Trauma and Orthopaedics, Royal Orthopaedic Hospital, Birmingham, GBR.
³ Orthopaedics, Wythenshawe Hospital, Birmingham, GBR.

Abstract

Digital templating using pre-operative radiographs enables pre-operative planning for total hip arthroplasty (THA). This allows surgeons to reproduce hip biomechanics effectively, reducing the risk of post-operative complications. Pelvic radiographs demonstrating the head, neck, trochanters, and proximal one-third of the femoral shaft allow calculation of key measurements including femoral offset and limb length discrepancy (LLD). Currently, no standardised guideline exists for obtaining pre-operative radiographs for templating in THA. Materials and methods: A single-blinded retrospective cohort study assessing the quality of pre- and post-operative radiographs of 195 patients who underwent elective THA for osteoarthritis over a two-year period was performed. Quality was rated as good, fair or poor, respectively, depending upon whether ≥2, 1 or none of the following were met: Pubic symphysis (PS) and coccyx in a straight line with 1-3 cm between the superior edge of the PS and tip of coccyx, trochanters distinguishable, obturator rings symmetric. Post-operative images were assessed to determine whether the distal end of the implanted prosthesis was visible. Results: The sample consisted of 195 patients. Pre-operatively 115 (59%) radiographs were classified as good, 71 (36.4%) fair and 9 (4.6%) poor. Post-operatively 46 (23.6%) were classified as good, 114 (58.4%) as fair and 30 (15.4%) as poor. In the post-operative radiographs, 25.6% did not include the distal tip of the prosthesis. Conclusion: This study highlights significant scope to improve the quality of pre-operative radiographs, allowing accurate templating to optimise outcomes for THA. A protocol is recommended whereby the pelvic radiograph is centred on the PS at the lesser trochanter level, ensuring adequate exposure of the proximal femur, acetabulum and iliac crests.

Keywords: general radiology; hip arthritis; hips; musculoskeletal radiology; orthopaedics & traumatology; preoperative templating; total hip arthroplasty: tha.