Digital Templating in Primary Total Hip and Knee Arthroplasty

Levine, Brett R.; Fabi, David; Deirmengian, Carl

doi:10.3928/01477447-20100924-04

Cited by 65 publications

(62 citation statements)

References 12 publications

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“…15 These results are comparable to previous findings by the current authors that digital templating accurately predicted tibial size in 63% and femoral size in 69% of 176 consecutive TKAs. 4 Results from the current study showed a significant improvement in templating accuracy to 90% for tibial and 83% for femoral component sizes. Increased experience with digital templating by the senior author was likely the cause for the improved templating accuracy.…”

Section: Discussionmentioning

confidence: 53%

“…In addition, as TDI continues to be refined and integrated in hospital systems, less instrumentation could help improve tray and operating room turnover to allow for more cases to be completed, minimize surface area for contamination, and lower hospital costs per procedure. 4 Inventory control by vendors using scheduling software to control inventory more tightly could improve operating room efficiency and reduce manufacturing costs.…”

Section: Discussionmentioning

confidence: 99%

“…1,3-7 Studies have confirmed the accuracy of digital templating compared with standard acetate templating and its ability to correctly predict the size of TKA components used intraoperatively. 1,3,4,8,9 The current authors previously reported that digital templating is an effective means for predicting the size of TKA components and can be performed by personnel across different levels of orthopedic training with reliable and reproducible results. 4, 10 The rising cost of health care in the United States is at the forefront of national debate and represents a serious threat to societal infrastructure.…”

Section: Template-directed Instrumentation In Total Knee Arthroplastymentioning

confidence: 96%

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Template-directed Instrumentation in Total Knee Arthroplasty: Cost Savings Analysis

Hsu¹,

Gross²,

Bhatia³

et al. 2012

Orthopedics

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The use of digital radiography and templating software in total knee arthroplasty (TKA) continues to become more prevalent as the number of procedures performed increases every year. Template-directed instrumentation (TDI) is a novel approach to surgical planning that combines digital templating with limited intraoperative instruments. The purpose of this study was to evaluate the financial implications and radiographic outcomes of using TDI to direct instrumentation during primary TKA. Over a 1-year period, 82 consecutive TKAs using TDI were retrospectively reviewed. Patient demographics and preoperative templated sizes of predicted components were recorded, and OrthoView digital planning software (OrthoView LLC, Jacksonville, Florida was used to determine the 2 most likely tibial and femoral component sizes for each case. This sizing information was used to direct component vendors to prepare 3 lightweight instrument trays based on these sizes. The sizes of implanted components and the number of total trays required were documented. A cost savings analysis was performed to compare TDI and non-TDI surgical expenses for TKA. In 80 (97%) of 82 cases, the prepared sizes determined by TDI using 3 instrument trays were sufficient. Preoperative templating correctly predicted the size of the tibial and femoral component sizes in 90% and 83% of cases, respectively. The average number of trays used with TDI was 3.0 (range, 3-5 trays) compared with 7.5 (range, 6-9 trays) used in 82 preceding non-TDI TKAs. Based on standard fees to sterilize and package implant trays (approximately $26 based on a survey of 10 orthopedic hospitals performing TKA), approximately $9612 was saved by using TDI over the 1-year study period. Overall, digital templating and TDI were a simple and cost-effective approach when performing primary TKA.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Template-directed Instrumentation In Total Knee Arthroplastymentioning

confidence: 96%

See 1 more Smart Citation

Template-directed Instrumentation in Total Knee Arthroplasty: Cost Savings Analysis

Hsu¹,

Gross²,

Bhatia³

et al. 2012

Orthopedics

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“…Standardization of the acquisition of radiographic images is essential for accurate measurement of distances and their biomechanical interpretation (Levine et al 2010). While the most common calibration method is based on an extracorporeal metallic sphere with a defined diameter positioned at the supposed vertical height of the center of the hip, intracorporeal implants have also been used successfully (Meyer and Kotecha 2008, Paul et al 2012).…”

Section: Discussionmentioning

confidence: 99%

The influence of hip rotation on femoral offset in plain radiographs

Lechler¹,

Frink²,

Gulati³

et al. 2014

Acta Orthopaedica

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Background and purposeAdequate restoration of femoral offset (FO) is critical for successful outcome after hip arthroplasty or fixation of hip fracture. Previous studies have identified that hip rotation influences the projected femoral offset (FOP) on plain anteroposterior (AP) radiographs, but the precise effect of rotation is unknown.Patients and methodsWe developed a novel method of assessing rotation-corrected femoral offset (FORC), tested its clinical application in 222 AP hip radiographs following proximal femoral nailing, and validated it in 25 cases with corresponding computed tomography (CT) scans.ResultsThe mean FORC was 57 (29–93) mm, which differed significantly (p < 0.001) from the mean FOP 49 (22–65) mm and from the mean femoral offset determined by the standard method: 49 (23–66) mm. FORC correlated closely with femoral offset assessed by CT (FOCT); the Spearman correlation coefficient was 0.94 (95% CI: 0.88–0.97). The intraclass correlation coefficient for the assessment of FORC by AP hip radiographs correlating the repeated measurements of 1 observer and of 2 independent blinded observers was 1.0 and 1.0, respectively.InterpretationHip rotation affects the FOP on plain AP radiographs of the hip in a predictable way and should be adequately accounted for.

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“…The inclination angle was defined as the angle between the line joining the inferior teardrop points and the axis of the opening of the acetabular component. Acetabular anteversion was measured with computer software (Advanced CasePlan Digital Templating Planning Software, Stryker Orthopedics, Mahwah, NJ) [14]. The mean inclination angle of the cup was 44° (23–70°), and the mean anteversion angle was 14° (4–25°).…”

Section: Methodsmentioning

confidence: 99%

Factors associated with symptomatic pseudotumors following metal-on-metal total hip arthroplasty

Hasegawa

Naito

Yamaguchi

et al. 2016

BMC Musculoskelet Disord

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BackgroundPseudotumors associated with metal-on-metal hips can be symptomatic or asymptomatic. The purpose of this study was to identify the characteristics of pseudotumors associated with pain.MethodsA total of 239 large-diameter, metal-on-metal total hip arthroplasties (THAs) were performed in 222 patients. Screening for pseudotumors was performed using magnetic resonance imaging (MRI) in all patients who underwent metal-on-metal THA, and 57 patients with 62 affected hips showed pseudotumors. There were 45 women with 49 hips and 12 men with 13 hips affected, with a mean age of 64 years and a mean body mass index (BMI) of 23.9 kg/m2. Sixteen hips had symptomatic pseudotumors with pain, and 46 hips were asymptomatic. Pseudotumor size was determined. The anatomical position of pseudotumors was divided into anterior position and posterolateral position. Types of pseudotumors were divided into two types: cystic type; and mixed solid cystic and solid type without a cystic component. The follow-up study of pseudotumors was determined using MRI in 33 patients. The serum cobalt and chromium ion levels were measured in 38 patients after unilateral THA. Univariate and multivariate analyses were performed comparing symptomatic and asymptomatic patients to identify the characteristics of symptomatic pseudotumors.ResultsThe mean BMI was 25.4 kg/m2 in symptomatic patients and 23.4 kg/m2 in asymptomatic patients; a higher BMI was associated with symptoms (P = 0.036). Symptomatic pseudotumors were significantly larger (three-fold) than asymptomatic pseudotumors (1812 mm2 vs 642 mm2, P = 0.003). Pseudotumors located in the anterior position were associated with symptoms (P = 0.032), and mixed solid cystic and solid type pseudotumors were associated with symptoms (P = 0.007). A multivariate analysis showed significant differences only in size (R 2 = 0.298, P = 0.031). No asymptomatic patients with pseudotumors became symptomatic during the follow-up period of MRI evaluation.ConclusionLarger size was a significant factor for pain on multivariate analysis.

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Digital Templating in Primary Total Hip and Knee Arthroplasty

Cited by 65 publications

References 12 publications

Template-directed Instrumentation in Total Knee Arthroplasty: Cost Savings Analysis

Template-directed Instrumentation in Total Knee Arthroplasty: Cost Savings Analysis

The influence of hip rotation on femoral offset in plain radiographs

Factors associated with symptomatic pseudotumors following metal-on-metal total hip arthroplasty

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