Comparative Analysis and Accuracy of Surgeon- and Prosthesis Manufacturer–Generated Radiographic Templates in Total Hip Arthroplasty

Background Preoperative templating in total hip arthroplasty (THA) improves surgical accuracy and predictability. Recently, prosthesis manufacturers (PMs) have introduced industry-generated templating systems, but their accuracy compared to surgeon-generated templates has yet to be evaluated. Methods A retrospective review was conducted on THAs performed by 2 surgeons between October 2023 and September 2024. Surgeon-generated and PM-generated templates were compared to actual implanted components. Accuracy of acetabular and femoral component sizing, as well as femoral offset prediction, was assessed using χ 2 analysis ( P < .05). Subgroup analyses examined the influence of patient sex and body mass index on accuracy. Results A total of 306 surgeon templates and 240 PM templates were analyzed. Surgeons correctly predicted acetabular and femoral component sizes in 45.1% and 28.4% of cases, respectively, while PM templates achieved 33.8% and 35.0%. No significant difference was found between groups in component size accuracy (acetabular: P = .09; femoral: P = .08). However, surgeons demonstrated significantly greater accuracy in offset prediction (83.7% vs 73.3%, P = .003). Additionally, surgeon-generated femoral component accuracy was significantly associated with patient body mass index ( P < .001). Conclusions PM templating demonstrated a reasonable ability to predict implant sizes in THA, with comparable performance to high-volume, fellowship-trained arthroplasty surgeons. While surgeon-generated templates outperformed PM templates in offset prediction, these findings suggest that industry-generated templates could be a valuable tool for surgical planning and inventory management in hospitals.