Preoperative templating and its intraoperative applications for hip resurfacing arthroplasty

Hip resurfacing arthroplasty (HRA) is a viable alternative to total hip arthroplasty (THA) in the younger, active adult with degenerative hip disease. However, hip resurfacing has proven to be technically demanding, as accurate component positioning is crucial for success, yet difficult to obtain. Risks of malpositioning of the femoral head include femoral neck notching, varus/valgus malalignment, and femoral neck fracture, while malpositioning of either component may lead to increased edge loading and metal ion levels. A thorough preoperative plan, including a review of clinical findings, radiographic studies, and surgical templating for component size and positioning improves intraoperative accuracy and precision. Key aspects of formulating a methodical preoperative plan for HRA are reviewed. Pertinent aspects of the clinical and radiographic examinations, the technique of preoperative templating, its intraoperative application, clinical outcomes of various preoperative templating systems and intraoperative alignment guides, and the senior author's (EPS) preferred technique are presented.