Preoperative Planning for Primary Total Hip Arthroplasty

Preoperative planning is a fundamental aspect of reestablishing native biomechan- ics of the hip in total hip arthroplasty (THA). In the literature, many authors discuss the importance of preoperative X-ray review and measurement to establish the cor- rect positioning of the implant components [1–3]. Hip replacement surgery aims to restore the center of rotation of the coxofemoral articulation and femoral offset, focusing on equalizing limb length. Another important point is the opportunity for surgeons to evaluate the hip anatomy and estimate the implant sizes with a high level of precision [4–7]. When the preoperative planning coincides with intraopera- tive limb-length measurement, the incidence of dysmetria of lower limbs signifi- cantly decreases [8, 9], although mild dysmetria does not affect the patient’s outcome [10, 11]. The patient’s sex, age, hip anatomy, hip disease, medical history, level of activity, and expectations from the surgery need to be considered when choosing the type and design of the prosthesis. With the advent of technology, surgeons have reduced the use of printed radio- graph films, and templating is now done with computer software. However, tradi- tional templating with X-rays continues to be a good possible option. This chapter will describe an accurate and reproducible technique of preoperative radiograph templating for THA.