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Abstract
The purpose of this study was to determine the accuracy of preoperative templating
of primary, noncemented femoral components. A retrospective review of charts and radiographs
was performed on 74 hips in 64 patients who had undergone either noncemented total
hip arthroplasty (THA) or placement of an endoprosthesis (including bipolar). Preoperative
radiographs were templated by a total joint arthroplasty attending surgeon, a senior
orthopaedic resident, and a junior resident. The templated size corresponded to the
actual femoral implant used in approximately 50% of cases. When femoral prostheses
within one size above or below the templated size were included, the accuracy of preoperative
templating rose to 88-95%. When implants within two sizes of the templated size were
included, the accuracy approached 100%. Factors associated with discrepancies in the
size of femoral stem used included placement of an undersized implant, presence of
metal hardware that obscured the ability to template accurately, proximal bone deformity,
sclerotic bone, acute femoral neck fracture, and inadequate preoperative radiographs.
The accuracy of templating increased gradually with the level of training. The most
experienced investigator was able to template within one size of the actual implant
used in 95% of cases, compared with 88% and 82% for the less experienced investigators.
Acute femoral neck fractures and proximal bone deformity were associated with the
largest discrepancies in templated sizes.