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

Area of Science:

• Orthopedic Surgery
• Radiology
• Medical Imaging

Background:

• Digital templating with pre-operative radiographs aids total hip arthroplasty (THA) planning, improving biomechanics and reducing complications.
• Accurate measurements like femoral offset and limb length discrepancy (LLD) rely on quality pelvic radiographs.
• No standardized guidelines currently exist for obtaining pre-operative radiographs for THA templating.

Purpose of the Study:

• To assess the quality of pre-operative and post-operative radiographs in patients undergoing elective total hip arthroplasty (THA).
• To identify areas for improvement in radiographic technique for better surgical planning.
• To evaluate the consistency and adequacy of imaging for prosthesis templating and assessment.

Main Methods:

• A single-blinded retrospective cohort study of 195 patients undergoing elective THA for osteoarthritis.
• Radiograph quality was assessed based on specific criteria: pubic symphysis/coccyx alignment, trochanter visibility, and obturator ring symmetry.
• Post-operative radiographs were evaluated for the visibility of the distal prosthesis tip.

Main Results:

• 59% of pre-operative radiographs were rated good, 36.4% fair, and 4.6% poor.
• Post-operative radiograph quality showed a decline, with 23.6% good, 58.4% fair, and 15.4% poor.
• 25.6% of post-operative images failed to include the distal tip of the prosthesis.

Conclusions:

• Significant improvements are needed in the quality of pre-operative radiographs for accurate THA templating and optimized outcomes.
• A standardized protocol is recommended, centering the pelvic radiograph on the pubic symphysis at the lesser trochanter level.
• Ensuring adequate visualization of the proximal femur, acetabulum, and iliac crests is vital for effective surgical planning.