Wong Joshua Rui Yen, Gibson Marc, Aquilina Julian, Parmar Deovrat, Subramanian Padmanabhan, Jaiswal Parag
Trauma and Orthopaedics, Royal Free Hospital, London, GBR.
Cureus. 2022 Mar 2;14(3):e22766. doi: 10.7759/cureus.22766. eCollection 2022 Mar.
Background Pre-operative planning and templating is a crucial pre-requisite for total hip arthroplasty (THA). Recently, the use of digital radiography has allowed templating to be digitalised instead of traditional methods involving the use of radiograph transparencies. The primary aim of this study was to compare the accuracy in correction of leg length discrepancy (LLD) and restoring femoral offset in patients undergoing THA for primary osteoarthritis with pre-operative digital templating (PDT) versus conventionalplanning without digital templating. Methods This retrospective cohort study compared two groups of patients who underwent THA for primary osteoarthritis. During the period of the year 2020, 56 patients underwent THA with pre-operative digital templating and 50 patients without digital templating. Two independent blinded observers recorded all radiological data. Results The digital templated and non-digital templated cohorts were matched for variables including age (mean = 71.8 years vs 70.9 years), pre-operative LLD (-4.9mm vs -5.2mm) and pre-operative offset (41.2mm vs 43.7mm). PDT resulted in correction of LLD to <5mm compared to the contralateral hip in 76.8% of cases, 5-10mm in 21.4% and >10mm in one case (1.8%). The non-digital templated cohort had a LLD of <5mm in 50% of cases, 5-10mm in 28% and >10mm in 22%. Chi-square testing demonstrated these results to be statistically significant (p = 0.002). The mean pre-operative offset in the digital templated group was 40mm and 46mm post-operatively. The non-digital templated cohort had a mean pre-operative offset of 42mm and 36mm post-operatively. Independent t-testing revealed statistical significance of these results (p = 0.05). Conclusion PDT leads to an increased likelihood of restoring LLD to <5mm and a significantly increased likelihood of preventing lengthening >10mm. PDT also significantly increases the chance of restoring femoral offset to match the pre-operative native hip. Decreased offset is seen predominantly in the non-digitally templated patients.
术前规划和模板制作是全髋关节置换术（THA）的关键前提条件。最近，数字放射成像的应用使得模板制作能够数字化，而非采用涉及使用射线照相透明片的传统方法。本研究的主要目的是比较在接受初次骨关节炎THA的患者中，使用术前数字模板制作（PDT）与不使用数字模板的传统规划在矫正肢体长度差异（LLD）和恢复股骨偏心距方面的准确性。方法：这项回顾性队列研究比较了两组因原发性骨关节炎接受THA的患者。在2020年期间，56例患者接受了术前数字模板制作的THA，50例患者未进行数字模板制作。两名独立的盲法观察者记录了所有放射学数据。结果：数字模板制作组和非数字模板制作组在年龄（平均分别为71.8岁和70.9岁）、术前LLD（-4.9mm对-5.2mm）和术前偏心距（41.2mm对43.7mm）等变量上相匹配。与对侧髋关节相比，PDT使76.8%的病例LLD矫正至<5mm，21.4%的病例矫正至5 - 10mm，1例（1.8%）矫正至>10mm。非数字模板制作组中，50%的病例LLD<5mm，28%的病例矫正至5 - 10mm，22%的病例矫正至>10mm。卡方检验表明这些结果具有统计学意义（p = 0.002）。数字模板制作组术前平均偏心距为40mm，术后为46mm。非数字模板制作组术前平均偏心距为42mm，术后为36mm。独立t检验显示这些结果具有统计学意义（p = 0.05）。结论：PDT使将LLD恢复至<5mm的可能性增加，显著提高了防止延长>10mm的可能性。PDT还显著增加了恢复股骨偏心距以匹配术前天然髋关节的机会。偏心距减小主要见于未进行数字模板制作的患者。
