Digital templating in total hip arthroplasty in the NHS: ‘computer says no…’

Preoperative planning plays an important role in any surgical procedure and total hip replacement (THR) is no exception. Templating of radiographs allows preoperative assessment of the correct size of implant to be used, lowers the risk of periprosthetic fracture, helps restore femoral offset and leg length, facilitates the optimisation of alignment and ensures the correct implants sizes are available. All of these reduce the intraoperative pressures leading to the selection of incorrectly sized implants. This study assessed whether there is adequate provision of the current NHS Picture Archiving and Communication Systems (PACS) to allow optimal digital templating for THRs. Data were collected using a telephone questionnaire requesting information from the on-call orthopaedic SpR in 28 Greater London and surrounding area NHS Hospitals. PACS were used in all 28 (100%) hospitals that were contacted. Digital templating software was available in 14 (50%) hospitals. Despite this, none of them performed digital templating regularly. In the 50% that did have digital templating, this was not routinely done for the following reasons; only 3 (10.7%) allowed easy access to the software to the SpRs; only one SpR received formal training on how to use the system; only one hospital regularly used methods to accurately allow the software to assess magnification for accurate sizing (e.g. sizing balls). Digital PACS systems have made great improvements in the access of radiographs in the NHS. In orthopaedic practice, however, we have shown that the benefit of digital templating is being overlooked within the NHS.