Reproducibility of Digital Planning in Cementless Total Hip Arthroplasty Among Experienced and Novice Surgeons

Fabricio, Marcelo Zerbetto; Rudelli, Bruno Alves; Miyahara, Helder de Souza; Ejnisman, Leandro; Gurgel, Henrique de Melo Campos; Croci, Alberto Tesconi

doi:10.1055/s-0042-1750758

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Revista Brasileira de Ortopedia

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Original Article • Rev. bras. ortop. 58 (2) • Mar-Apr 2023 • https://doi.org/10.1055/s-0042-1750758 copy

Reproducibility of Digital Planning in Cementless Total Hip Arthroplasty Among Experienced and Novice Surgeons

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study aims to assess the reproducibility of digital planning for cementless total hip arthroplasty (THA) among surgeons with different levels of experience. In addition, it attempts to determine the degree of planning reliability based on a contralateral THA or on a spherical marker positioned at the greater trochanter for calibration.

Methods

Two evaluators with different experience levels (A1 and A2) performed independently the retrospective digital surgical planning of 64 cementless THAs. Next, we compared the planning with the implants used in the surgery. The reproducibility was excellent when planning and implants were identical; proper in case of a single-unit variation; and inappropriate if there was variation in two or more units. The present analysis also determined the calibration accuracy between the contralateral THA and the spherical marker at the greater trochanter level.

Results

The present study demonstrated greater success when the most experienced evaluator performed the planning and greater accuracy for the contralateral THA. When splitting the analysis per parameter (contralateral THA or spherical marker), there was a statistical difference only for the planning of A1 and the implants used in the surgery. This difference occurred in the excellent category, with 67.3% for contralateral THA compared with 30.6% for a spherical marker (p < 0.001), and in the inappropriate category, with 7.1% for contralateral THA compared with 30.6% for a spherical marker (p < 0.001).

Conclusions

Digital planning is more accurate when performed by an experienced evaluator. The contralateral prosthesis head was a better reference than a marker on the greater trochanter.

Keywords
arthroplasty, replacement, hip; hip prosthesis; digital planning; patient care planning; radiography

		n	%	p-value
Gender	Female	34	53.1%	0.480
Gender	Male	30	46.9%	0.480
Parameter	Contralateral THA	52	81.3%	< 0.001
Parameter	Spherical marker	12	18.8%	< 0.001

		Excellent		Proper		Inappropriate
		n	%	n	%	n	%
Contralateral THA	Surgery – Expert (A1)	105	67.3%	40	25.6%	11	7.1%
	Surgery – Novice (A2)	44	28.2%	50	32.1%	62	39.7%
	Novice – Expert (B)	51	32.7%	55	35.3%	50	32.1%
Head, 28-mm	Surgery – Expert (A1)	11	30.6%	14	38.9%	11	30.6%
	Surgery – Novice (A2)	6	16.7%	16	44.4%	14	38.9%
	Novice – Expert (B)	13	36.1%	7	19.4%	16	44.4%
All	Surgery – Expert (A1)	116	60.4%	54	28.1%	22	11.5%
	Surgery – Novice (A2)	50	26.0%	66	34.4%	76	39.6%
	Novice – Expert (B)	64	33.3%	62	32.3%	66	34.4%

		Excellent	Proper	Inappropriate
Contralateral THA	A1-A2	< 0.001	0.211	< 0.001
	A1-B	< 0.001	0.065	< 0.001
	A2-B	0.389	0.549	0.157
Head, 28mm	A1-A2	0.165	0.633	0.458
	A1-B	0.617	0.070	0.224
	A2-B	0.061	0.023	0.633
All	A1-A2	< 0.001	0.186	< 0.001
	A1-B	< 0.001	0.374	< 0.001
	A2-B	0.118	0.665	0.290

			Excellent		Proper		Inappropriate
			n	%	n	%	n	%
Contralateral THA	Neck	Surgery – Expert (A)	40	76.90%	10	19.20%	2	3.80%
		Surgery – Novice (B)	15	28.80%	13	25.00%	24	46.20%
		Novice – Expert (C)	14	26.90%	18	34.60%	20	38.50%
	Stem	Surgery – Expert (A)	30	57.70%	15	28.80%	7	13.50%
		Surgery – Novice (B)	17	32.70%	18	34.60%	17	32.70%
		Novice – Expert (C)	22	42.30%	16	30.80%	14	26.90%
	Cup	Surgery – Expert (A)	35	67.30%	15	28.80%	2	3.80%
		Surgery – Novice (B)	12	23.10%	19	36.50%	21	40.40%
		Novice – Expert (C)	15	28.80%	21	40.40%	16	30.80%
Spherical marker	Neck	Surgery – Expert (A)	7	58.30%	5	41.70%	0	0.00%
		Surgery – Novice (B)	3	25.00%	6	50.00%	3	25.00%
		Novice – Expert (C)	4	33.30%	3	25.00%	5	41.70%
	Stem	Surgery – Expert (A)	2	16.70%	4	33.30%	6	50.00%
		Surgery – Novice (B)	1	8.30%	6	50.00%	5	41.70%
		Novice – Expert (C)	6	50.00%	1	8.30%	5	41.70%
	Cup	Surgery – Expert (A)	2	16.70%	5	41.70%	5	41.70%
		Surgery – Novice (B)	2	16.70%	4	33.30%	6	50.00%
		Novice – Expert (C)	3	25.00%	3	25.00%	6	50.00%

			Excellent	Proper	Inappropriate
Contralateral THA	Neck	A-B	< 0.001	0.478	< 0.001
		A-C	< 0.001	0.077	< 0.001
		B-C	0.827	0.284	0.427
	Stem	A-B	0.01	0.527	0.02
		A-C	0.117	0.83	0.087
		B-C	0.311	0.676	0.52
	Cup	A-B	< 0.001	0.403	< 0.001
		A-C	< 0.001	0.216	< 0.001
		B-C	0.502	0.687	0.306
Spherical marker	Neck	A-B	0.098	0.682	0.064
		A-C	0.219	0.386	0.012
		B-C	0.653	0.206	0.386
	Stem	A-B	0.537	0.408	0.682
		A-C	0.083	0.132	0.682
		B-C	0.025	0.025	1
	Cup	A-B	1	0.673	0.682
		A-C	0.615	0.386	0.682
		B-C	0.615	0.653	1

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Marcelo Zerbetto Fabricio, MD, Hip Group of the Institute of Orthopedics and Traumatology of HC/FMUSP, Benedito Osvaldo Lecques Street, Parque Resid Aquarius, São José dos Campos, SP, 12246-021, Brazil (e-mail: drmarcelozf@gmail.com).