Efficacy of the use of templating in total hip arthroplasty

Forty-three anteroposterior X-rays were analyzed by three experienced surgeons (A, B, C) and compared. Cohen's Kappa concordance test and weighted Kappa indexes using quadratic weighting were used for statistical analysis with a confidence interval of 95%.

RESULTS:

The preoperative evaluations were divided into the analysis of the sizes of the acetabular cup, stem and plug of the distal femoral canal. Surgeon A obtained a moderate agreement in relation to the acetabular component and substantial agreements in relation to the stem and plug. Surgeon B had moderate agreement in relation to both the acetabulum and the stem and substantial agreement in relation to the plug. Surgeon C obtained moderate agreement in relation to the analysis of the acetabulum and the plug and substantial agreement for the stem. The intraobserver agreement test demonstrated a prevalence of slight agreement in relation to the acetabulum and substantial agreement in relation to the stem and to the plug.

CONCLUSION:

Templating used in preoperative planning proved effective; however, there was a prevalence of slight and moderate agreement in relation to the size of the acetabular component.

Pelvis; Arthroplasty; Hip/radiography

Acetabulum (type)	Results (patients)	%
44	12	28
48	15	34.8
52	15	34.8
56	1	2.4

Size of stem (type)	Results (patients)	%
35.5	3	8
37.5-1	14	32
37.5-2	3	8
37.5-3	0	0
44-1	8	18
44-2	10	23
44-3	3	8
44-4	2	4

Size of plug (type)	Results (patients)	%
10	7	17
12	13	30
14	14	32
16	6	14
18	2	4.5
20	1	2.5

	Kappa	95% CI	Linear weighted kappa	95% CI	Quadratic weighted kappa	95% IC	Concordance of the results
A. acet x B. acet	0.16	-0.03 to 0.36	0.26	0.08 to 0.45	0.355	0.105 to 0.60	Mild
A. stem x B. stem	0.55	0.32 to 0.78	0.60	0.30 to 0.90	0.67	0.26 to 1.0	Substantial
A. plug x B. plug	0.43	0.23 to 0.63	0.65	0.35 to 0.96	0.83	0.32 to 1.0	Perfect
A. acet x C. acet	0.57	0.37 to 0.76	0.64	0.39 to 0.89	0.72	0.37 to 1.0	Substantial
A. stem x C. stem	0.75	0.57 to 0.94	0.78	0.48 to 1.0	0.81	0.41 to 1.0	Substantial
A. plug x C. plug	0.16	-0.02 to 0.33	0.47	0.31 to 0.63	0.71	0.47 to 0.95	Substantial
A. acet x R. acet	0.02	-0.16 to 0.20	0.33	0.20 to 0.45	0.60	0.45 to 0.76	Moderate
A. stem x R. stem	0.46	0.22 to 0.71	0.52	0.20 to 0.84	0.61	0.16 to 1.0	Substantial
A. plug x R. plug	0.33	0.13 to 0.53	0.57	0.28 to 0.86	0.75	0.21 to 1.0	Substantial
B. acet x C. acet	0.26	0.06 to 0.47	0.30	0.12 to 0.49	0.33	0.10 to 0.55	Mild
B. stem x C. stem	0.63	0.41 to 0.84	0.66	0.35 to 0.97	0.72	0.30 to 1.0	Substantial
B. plug x C. plug	0.28	0.08 to 0.48	0.48	0.25 to 0.70	0.65	0.36 to 0.93	Substantial
B. acet x R. acet	0.18	-0.04 to 0.40	0.29	0.13 to 0.46	0.41	0.17 to 0.65	Moderate
B. stem x R. stem	0.33	0.08 to 0.58	0.37	0.12 to 0.69	0.43	0.11 to 0.73	Moderate
B. plug x R. plug	0.33	0.13 to 0.54	0.50	0.20 to 0.79	0.66	0.04 to 1.0	Substantial
C. acet x R. acet	0.12	-0.09 to 0.32	0.33	0.19 to 0.46	0.55	0.30 to 0.79	Moderate
C. stem x R. stem	0.55	0.32 to 0.78	0.59	0.27 to 0.91	0.66	0.22 to 1.0	Substantial
C. plug x R. plug	0.14	-0.03 to 0.32	0.35	0.21 to 0.49	0.54	0.29 to 0.80	Moderate

	Kappa	95% CI	Linear weighted kappa	95% CI	Quadratic weighted kappa	95% IC	Concordance of the results
A. acet x B. acet	0.16	-0.03 to 0.36	0.26	0.08 to 0.45	0.355	0.105 to 0.60	Mild
A. acet x C. acet	0.57	0.37 to 0.76	0.64	0.39 to 0.89	0.72	0.37 to 1.0	Substantial
A. acet x R. acet	0.02	-0.16 to 0.20	0.33	0.20 to 0.45	0.60	0.45 to 0.76	Moderate
B. acet x C. acet	0.26	0.06 to 0.47	0.30	0.12 to 0.49	0.33	0.10 to 0.55	Mild
B. acet x R. acet	0.18	-0.04 to 0.40	0.29	0.13 to 0.46	0.41	0.17 to 0.65	Moderate
C. acet x R. acet	0.12	-0.09 to 0.32	0.33	0.19 to 0.46	0.55	0.30 to 0.79	Moderate

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] *Corresponding author at: Clinica de Ortopedia e Traumatologia. Rua 13 de maio, 940. Catanduva, SP, Brazil. CEP 15800-000. Phone/Fax: (17) 3522-3104. E-mail: fsdevito@uol.com.br