International Orthopaedics

, Volume 43, Issue 8, pp 1799–1805 | Cite as

Influence of calibration on digital templating of hip arthroplasty

  • Christoph Kolja BoeseEmail author
  • Sebastian Wilhelm
  • Stefan Haneder
  • Philipp Lechler
  • Peer Eysel
  • Jan Bredow
Original Paper



Digital templating for total joint replacement is the current standard. For image calibration, external calibration markers (ECM) are used. However, there are concerns regarding the precision of the method. This study aimed to identify the direct influence of calibration errors on digital templating.

Patients and methods

A retrospective analysis of 100 post-operative radiographs with unilateral total hip arthroplasty was performed. The magnification factor of the ECM and of the internal prosthetic femoral head (ICM) as a reference value was calculated for each radiograph. Two blinded observers performed templating of the contralateral hip using a randomized list for all radiographs and both markers. The component size templated by the ECM magnification was compared to the reference by the ICM magnification.


Mean magnification factors of ICM and ECM differed significantly (p = 0.006). The absolute difference was 5.2% (range 0.0–23.3%, SD 4.8%). Templating of the acetabular or the femoral component showed no significant differences (p = 0.120, p = 0.599). Differences of more than one size were found in 26% of the acetabular components and 14% of the femoral components and differences over two sizes in 10% respectively 3%. Correlation coefficients for magnification error and size differences of acetabular components were − 0.645 (p < 0.001) and for the femoral component − 0.607 (p < 0.001).


The calibration error of external calibration markers in digital templating for hip replacement influences component sizes significantly. Thus, correct positioning of ECM is of utmost importance.


Total hip arthroplasty Digital templating Radiography Calibration 





External calibration marker


Internal calibration marker (i.e., THA head)


Total hip arthroplasty



Parts of the study were presented at the annual meeting of German orthopedics and trauma surgeons in Berlin, Germany (DKOU) 2017.

Author contributions

All authors have participated in the research.

Data analysis: CKB, PL, and JB. Interpretation of data: CKB, JB, SW, and PL. Drafting of manuscript: CKB, JB, and PL. Critical review and writing of the manuscript: CKB, JB, SH, and PL. Approval of final version of the manuscript: all authors.


There is no funding source.

Compliance with ethical standards

Conflict of interest

CKB is an employee of Smith & Nephew GmbH. The other authors declare no relevant conflict of interest.

Ethical approval and informed consent

The study protocol followed the principles of the Declaration of Helsinki and following the local ethics committee, no formal informed consent was required for this retrospective analysis.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic and Trauma SurgeryUniversity Hospital of CologneCologneGermany
  2. 2.Institute of Diagnostic and Interventional RadiologyUniversity Hospital of CologneCologneGermany
  3. 3.Center of Orthopedic and Trauma SurgeryUniversity of Giessen and MarburgMarburgGermany
  4. 4.Department of Spine SurgerySchön Klinik DüsseldorfDüsseldorfGermany
  5. 5.Center for OrthopedicsSchön Klinik Düsseldorf SE & Co. KGDüsseldorfGermany

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