Salem Hytham S, Marchand Kevin B, Ehiorobo Joseph O, Tarazi John M, Matzko Chelsea N, Sodhi Nipun, Hepinstall Matthew S, Mont Michael A
Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York.
Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New York, New York.
Surg Technol Int. 2020 May 28;36:364-370.
Imaging studies for preoperative planning of total hip arthroplasty (THA) are typically obtained by two-dimensional (2D) anteroposterior radiographs. However, CT imaging has proven to be a valuable tool that may be more accurate than standard radiographs. The purpose of this review was to report on the current literature to assess the utility of CT imaging for preoperative planning of THA. Specifically, we assessed its utility in the evaluation of: 1) hip arthritis; 2) femoral head osteonecrosis; 3) implant size prediction; 4) component alignment; 5) limb length evaluation; and 6) radiation exposure.
A literature search was performed using search terms "computed tomography", "radiograph", "joint" "alignment", "hip," and "arthroplasty". Our initial search returned a total of 562 results. After applying our criteria, 26 studies were included.
CT scans were found to be more accurate than radiographs in predicting implant size and alignment preoperatively and provide improved visualization of extraarticular deformities that may be essential to consider when planning a THA. Although radiation is a potential concern, newer imaging protocols have minimized the radiation to levels comparable to x-ray.
The current literature suggests that CT has several advantages over radiographs for preoperative planning of THA including more accurate planning of implant size, component alignment, and postoperative leg length. It is also superior to x-ray in identifying extraarticular hip deformities using the minimum effective dose for CT and the minimum scan length required by templating software. The radiation can be reduced to values similar to radiography.
全髋关节置换术（THA）术前规划的影像学检查通常通过二维（2D）前后位X线片进行。然而，CT成像已被证明是一种有价值的工具，可能比标准X线片更准确。本综述的目的是报告当前文献，以评估CT成像在THA术前规划中的效用。具体而言，我们评估了其在以下方面的效用：1）髋关节关节炎；2）股骨头坏死；3）植入物尺寸预测；4）组件对线；5）肢体长度评估；以及6）辐射暴露。
使用搜索词“计算机断层扫描”、“X线片”、“关节”、“对线”、“髋关节”和“关节成形术”进行文献检索。我们的初步检索共返回562条结果。应用我们的标准后，纳入了26项研究。
发现CT扫描在术前预测植入物尺寸和对线方面比X线片更准确，并能更好地显示关节外畸形，这在规划THA时可能是需要考虑的关键因素。尽管辐射是一个潜在问题，但新的成像方案已将辐射降至与X线相当的水平。
当前文献表明，对于THA的术前规划，CT比X线片有几个优势，包括更准确地规划植入物尺寸、组件对线和术后腿长。在使用CT的最小有效剂量和模板软件所需的最小扫描长度识别关节外髋关节畸形方面，它也优于X线片。辐射可以降低到与X线摄影相似的值。
