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ORIGINAL PAPER

Effects of surgeon experience and patient characteristics on accuracy of digital pre-operative planning in total hip arthroplasty Ittai Shichman 1 & Shai Factor 1 & Or Shaked 1 & Samuel Morgan 1 & Nissan Amzallag 1 & Aviram Gold 1 & Nimrod Snir 1 & Yaniv Warschawski 1 Received: 18 June 2020 / Accepted: 14 July 2020 # SICOT aisbl 2020

Abstract Background The effect of surgeon experience on accuracy of digital pre-operative planning for total hip arthroplasty (THA) remains unclear. The aims of our study were to compare pre-operative planning accuracy between fellow-trained orthopaedic surgeons and residents and to explore whether surgery indication effects the prediction accuracy. Methods We prospectively reviewed 101 patients who underwent pre-operative digital templating for THA in our center from January 2019 to January 2020 with King Mark device. Extracted data included baseline characteristics and indication for primary arthroplasty. Pre-operative digital templating was performed separately by both a fellow-trained surgeon and a resident. Accuracy of each group was compared with the implanted components. Results The overall adequate pre-operative planning of the acetabular cup (exact or +/−1 size match) by the fellow-trained group was higher compared with the resident’s group (77.2 and 64.3% respectively, p = 0.037), whereas the overall adequate preoperative planning of the femoral stem (exact or +/−1 size match) was higher in the resident’s group compared with the fellowtrained group (83.2 and 61.4% respectively, p < =0.001). The fellow-trained group showed better pre-operative planning of complex cases (developmental dysplasia of the hip and avascular necrosis of femoral head) than the resident’s group. Conclusions The experience of the planner does not significantly affect the accuracy of correctly predicting component sizes. However, in complex cases, fellow-trained surgeons should assist residents in digital pre-operative templating for THA. Keywords Total hip arthroplasty . Digital templating . Calibration . TraumaCAD

Introduction Total hip arthroplasty (THA) is considered one of the most successful and common procedures performed in orthopaedics [1]. Pre-operative planning is an important aspect of this procedure. Templating has been proven to be helpful in the selecting the proper implant size, facilitating optimization of alignment, and reducing surgical time and risk of potential complications [2, 3]. Over the past decade, digital templating has replaced the conventional acetate templating radiography as the standard modality used in pre-operative planning [2]. The combination of digital radiography calibration and use of

* Yaniv Warschawski [email protected] 1

Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906 Tel Aviv, Israel

adaptable templating software that can accommodate various types and sizes of prostheses are essential for accurate preoperative planning [4]. T