Preoperative Templating Prior to Total Hip Arthroplasty: A Closed-Loop Audit.

Background: Preoperative templating is an essential process in total hip arthroplasty (THA), aiding surgical planning and implant selection to optimize patient outcomes. Despite its significance, templating is inconsistently practiced, influenced by factors such as surgeon experience and institutional protocols. In light of increasing THA rates, this study aimed to assess adherence to templating guidelines within our institution and evaluate the impact of a new protocol on compliance.

Methods: We conducted a closed-loop audit with an initial review of 50 THA cases, assessing the frequency and timing of preoperative templating. Following the first audit cycle, a departmental protocol was introduced, mandating templating radiographs 7-180 days before surgery, supported by a departmental rota. In the subsequent audit cycle, another 50 patients were reviewed. Templating was performed using TraumaCad software (Orthocrat Ltd, Petach Tikva, Israel) on anteroposterior pelvic radiographs with a calibration sphere. Statistical analysis was conducted using Welch's unpaired t-test. Leg length changes were evaluated in all patients based on their two most recent radiographs during the second audit cycle to determine if leg lengths had changed over time.

Results: In the pre-intervention cycle, only 20% of patients had templating radiographs within the recommended timeframe, with an average of 140 days between the most recent radiograph and surgery. Post-intervention, compliance improved significantly, with 70% of patients receiving templating radiographs within the specified period (p < 0.0001), and the average time between the most recent radiograph and surgery reduced to 33 days. A mean leg length change of 2.26 mm was observed, with changes ranging from 0 to 17 mm between radiographs. The mean interval between radiographs was 386 days.

Conclusion: This closed-loop audit found that implementing booking preoperative templating radiographs prior to THA and integrating them as part of the preoperative assessment process had a significant impact on the number of patients having appropriate imaging performed preoperatively. Simple interventions, such as the introduction of a roster, helped ensure compliance in the booking of departmental radiographs. This study has shown how patient parameters can change over time and emphasizes the importance of ensuring up-to-date imaging to allow accurate surgical planning.