Comparison of the accuracy of 2D and 3D templating methods for planning primary total hip replacement: a systematic review and meta-analysis

Abstract

There are advocates of both two-dimensional (2D) and three-dimensional (3D) templating methods for planning total hip replacement. The aim of this study was to compare the accuracy of implant size prediction when using 2D and 3D templating methods for total hip arthroplasty, as well as to compare the inter- and intra-observer reliability in order to determine whether currently available methods are sufficiently reliable and reproducible. Medline, EMBASE and PubMed were searched to identify studies that compared the accuracy of 2D and 3D templating for total hip replacement. Results were screened using the PRISMA flowchart and included studies were assessed for their level of evidence using the Oxford CEBM criteria. Non-randomized trials were critically appraised using the MINORS tool, whilst randomized trials were assessed using the CASP RCT checklist. A series of meta-analyses of the data for accuracy were also conducted. Ten studies reported that 3D templating is an accurate and reliable method of templating for total hip replacement. Six studies compared 3D templating with 2D templating, all of which concluded that 3D templating was more accurate, with three finding a statistically significant difference. The meta-analyses showed that 3D CT templating is the most accurate method. This review supports the hypothesis that 3D templating is an accurate and reliable method of preoperative planning, which is more accurate than 2D templating for predicting implant size. However, further research is needed to ascertain the significance of this improved accuracy and whether it will yield any clinical benefit.

Determining the accuracy of preoperative total hip replacement 2D templating using the mediCAD® software

“…Nowadays, many templating approaches and software are on the market, with varying accuracies. Although latest studies report three-dimensional CT-based software having better prediction accuracy than 2D digital templating, higher radiation exposure remains a critical demerit [ 16 ]. This study aimed at evaluating the accuracy of preoperative digital 2D templating of THA with mediCAD ® software and find the factors that influence the accuracy, including indication for surgery, patients’ demographics, implant brand, and the assessors’ grade of education.…”

“…When aiming for higher accuracy, 3D softwares show promising results [ 16 , 26 , 27 ]. However, it takes 10 times as much time as traditional 2D templating.…”

“…Currently, there are three different options for templating: acetate on digital images, 2D templating on digital images, and digital 3D templating [ 15 , 16 ]. Several commercialized software that allows digital planning is available; examples include King Mark [ 5 ], mediCAD-system [ 17 ] MATLAB software from MathWorks [ 18 ], Merge Healthcare [ 11 ], Apple’s Keynote presentation software [ 19 ], TraumaCad™ system [ 20 ], EndoMap software [ 21 ] and EOS imaging [ 22 ].…”

“…In terms of predicting the accurate size of the implant within one size, these values ranged from 45 to 89.3% for the cup and from 60.7 to 83.6% for the stem. The accuracy is significantly higher when using 3D templating methods [ 16 ]. This study aimed to evaluate the accuracy of preoperative templating of THA using the mediCAD ® software.…”

Deep Learning and Computer Vision Techniques for Automated Total Hip Arthroplasty Planning on 2-D Radiographs

“…However, our literature survey found few studies related to decision automation [50], [54], [60]. Most of the published studies have investigated hip joint segmentation or compared the accuracy and reliability of manual preoperative THA planning [24]- [59]. A detailed literature survey is presented in Section 2.…”