Factors related to disagreement in implant size between preoperative CT-based planning and the actual implants used intraoperatively for total hip arthroplasty

  • Takeshi Ogawa
  • Masaki Takao
  • Takashi Sakai
  • Nobuhiko Sugano
Original Article



In total hip arthroplasty, prediction of the optimal implant size is important in order to prevent perioperative complications. However, it is not easy to achieve complete agreement between the planned size and the actual size required appropriate implant fit. No previous report has adequately discussed the factors related to mismatch between predicted and actual implant sizes. The purpose was to report the results of a single surgeon case series of patients undergoing THA using computed tomography (CT)-based templating and the possible factors related to implant size mismatch.


The study included 141 hips of 126 patients who underwent primary total hip arthroplasty with CT-based navigation. We retrospectively reviewed the planned and actual implant sizes used in these patients. Cup position, cup orientation and stem alignment were evaluated as surgical factors that could possibly be related to mismatch in implant size. Cortical index and canal flare index were also evaluated as morphological factors.


The final inclusions in this study were 124 hips of 111 patients including 82% of those were developmental dysplasia of the hip. Agreement in implant size was seen for 94.4% of cups and 85.5% of stems, respectively. No related factors were found for cup size mismatch. Stem alignment in the sagittal and coronal planes showed significant differences between the size-matched stem group and the smaller stem group (\(p<0.05\)).


Implant size agreement rates between the three-dimensional plan and the actual implants used intraoperatively were high. However, broach alignment should be checked in the coronal and sagittal planes if the intraoperative broach is smaller than the planned size.


Total hip arthroplasty Implant size Preoperative planning CT-based navigation Three-dimensional planning 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards

Informed consent

For this type of study formal consent is not required.


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Copyright information

© CARS 2017

Authors and Affiliations

  • Takeshi Ogawa
    • 1
  • Masaki Takao
    • 1
  • Takashi Sakai
    • 2
  • Nobuhiko Sugano
    • 1
  1. 1.Department of Orthopaedic Medical EngineeringOsaka University Graduate School of MedicineSuitaJapan
  2. 2.Department of Orthopaedic SurgeryOsaka University Graduate School of MedicineSuitaJapan

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