Preoperative Templating Prior to Total Hip Arthroplasty: A Closed-Loop Audit

Area of Science:

• Orthopedic Surgery
• Radiology
• Surgical Planning

Background:

• Preoperative templating is crucial for total hip arthroplasty (THA) surgical planning and implant selection.
• Current templating practices are inconsistent, varying by surgeon experience and institutional guidelines.
• Increasing THA rates necessitate standardized and compliant templating procedures.

Purpose of the Study:

• To assess adherence to preoperative templating guidelines at an institution.
• To evaluate the impact of a newly implemented protocol on templating compliance.
• To analyze the influence of imaging timing on surgical planning accuracy in THA.

Main Methods:

• A closed-loop audit reviewed 50 THA cases before and after protocol implementation.
• A departmental protocol mandated templating radiographs 7-180 days pre-surgery, supported by a rota.
• TraumaCad software was used for templating on pelvic radiographs; leg length changes were assessed.

Main Results:

• Pre-intervention, only 20% of patients had timely templating radiographs (avg. 140 days pre-op).
• Post-intervention, compliance rose to 70% (p < 0.0001), with avg. time reduced to 33 days.
• A mean leg length change of 2.26 mm was noted between radiographs (mean interval 386 days).

Conclusions:

• Implementing booking protocols for preoperative templating radiographs significantly increased appropriate imaging for THA.
• Simple interventions like a departmental rota can ensure compliance with imaging booking.
• Up-to-date imaging is vital for accurate THA surgical planning due to potential patient parameter changes.