International Orthopaedics

, Volume 42, Issue 6, pp 1275–1282 | Cite as

Pre-operative templating for knee arthroplasty shows low accuracy with standard X-rays

  • Nelson Hiroyuki Miyabe Ooka
  • André Luiz Siqueira Campos
  • Vitor Mudesto da Fonseca
  • Luis Edmundo Oliveira Rodrigues
  • Edmilson Barbosa Filho
  • José Sérgio Franco
  • Rodrigo Satamini Pires e Albuquerque
  • Vinicius Schott Gameiro
Original Paper



The purpose of this study was to evaluate the accuracy and reliability of pre-operative templating in predicting the size of femoral and tibial components and the effect of coronal deformity on templating accuracy.


This was a retrospective study of 39 pre-operative templates prepared by three different surgeons with different levels of training. The accuracy and reliability measures were evaluated by alpha and kappa coefficients of agreement. The analysis of the effect of coronal deformity on the accuracy of the template was measured by the Spearman’s correlation test.


Templating was accurate for the femoral component in 28.21% of anterposterior (AP) radiographs and 35.90% of lateral radiographs. Kappa coefficients were respectively 0.111 (95% confidence interval [95%CI]: –0.19 to 0.241) and 0.200 (95%CI: –0.010 to 0.401), indicating poor agreement. Templating accuracy for the tibial component were, respectively, 37.61% and 47.01% for AP and lateral views. Kappa coefficients were 0.186 (95%CI: –0.070 to 0.379) for the AP view and 0.315 (95%CI: –0.199 to 0.431) for the lateral view, showing poor and slight agreement respectively. Considering a margin of error of ±1 sizes, the agreement level improved for all components, particularly for tibia, where agreement levels become very good. The inter-observer agreement was fair for all components, except for the lateral view of the femoral component, whose agreement was good. The Spearman correlation test showed no correlation between accuracy of templating and coronal deformity.


Pre-operative templating is an unreliable and inaccurate tool. There is no relation between coronal deformity and accuracy of templating.


Total knee replacement Templating Precision Accuracy 


Compliance with ethical standards

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Disclosure of potential conflicts of interest

NHMO, ALSC, VMF, LEOR, JSF, RSPA, and VSG declare they have no conflict of interest.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Nelson Hiroyuki Miyabe Ooka
    • 1
  • André Luiz Siqueira Campos
    • 1
  • Vitor Mudesto da Fonseca
    • 1
  • Luis Edmundo Oliveira Rodrigues
    • 1
  • Edmilson Barbosa Filho
    • 1
  • José Sérgio Franco
    • 2
  • Rodrigo Satamini Pires e Albuquerque
    • 3
  • Vinicius Schott Gameiro
    • 3
  1. 1.Knee Surgery Group, Orthopaedic DepartmentHospital Federal dos Servidores do Estado do Rio de Janeiro (HFSE-RJ)Rio de JaneiroBrazil
  2. 2.Orthopaedics DepartmentUniversidade Federal do Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
  3. 3.Department of General and Specialized SurgeryUniversidade Federal Fluminense (UFF)NiteróiBrazil

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