• Erel Ben-Ari, Ittai Shichman, Ethan Sissman, Christian Oakley, Matthew Hepinstall, and Ran Schwarzkopf.
• Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA. erel.benari@gmail.com.
• Arch Orthop Trauma Surg. 2023 Nov 1; 143 (11): 687568816875-6881.

IntroductionPreoperative planning of total hip arthroplasty (THA) using two-dimensional low-dose (2DLD) full-body imaging has gained popularity in recent years. The low-dose imaging system is said to produce a calibrated image with constant 1:1 magnification. However, the planning software used in conjunction with those images may introduce variations in the degree of magnification in 2DLD imaging, and this has not yet been investigated. The purpose of the present study was to quantify any variation in 2DLD image to assess the need for image calibration when using conventional planning software.MethodsPostoperative 2DLD images from 137 patients were retrospectively evaluated. Only patients who underwent THA for primary osteoarthritis were included in the study cohort. The femoral head diameter was measured by two independent observers using both Orthoview™ and TraumaCad™ planning software programs. Actual sizes of the femoral head implants were extracted from surgical reports to calculate image magnification. Magnification measurement reliability was calculated with the intra-class correlation coefficient (ICC) index.ResultsImage magnification varied among cases (mean 133%, range 129-135%). There was no statistical difference in mean image magnification among the various implant sizes (p = 0.8). Mean observer and inter-observer reliability was rated excellent.ConclusionTHA planning with 2DLD imaging is subject to variation in magnification as analyzed with conventional planning software in this series. This finding is of paramount importance for surgeons using 2DLD imaging in preparation for THA since errors in magnification could affect the accuracy of preoperative planning and ultimately the clinical outcome.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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