Impact of intertrochanteric bone mineral density on the accuracy of preoperative templating in cementless total hip arthroplasty: a retrospective cohort study of 510 hips.
- 1Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea.
- 2Department of Orthopedic Surgery, Mirae Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.
- 3Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea. [email protected].
Abstract
Background
Preoperative templating accuracy in cementless total hip arthroplasty (THA) may be influenced by patient-specific and radiographic factors, yet bone quality has rarely been considered. We hypothesized that bone mineral density (BMD), and particularly intertrochanteric BMD, would be associated with femoral stem size discrepancy.Methods
In a retrospective cohort of 510 hips (467 patients) undergoing primary cementless THA, we compared templated and actual implant sizes for both femoral and acetabular components and assessed clinical and radiographic variables, including age, sex, weight, body mass index, BMD (T-score) at multiple proximal femoral sites, Dorr classification, and surgeon training level, using univariate and multivariable linear regression. Receiver operating characteristic analysis evaluated the discriminative performance of BMD for substantial stem size discrepancies.Results
No factor was associated with acetabular cup size discrepancy. Age, weight, and intertrochanteric BMD were independently associated with femoral stem size discrepancy, with intertrochanteric BMD showing the strongest association among the variables examined (standardized β = -0.326). A T-score cutoff of - 0.9 was associated with discrepancies of at least three sizes larger than templated (area under the curve 0.782), and a cutoff of 0.2 with discrepancies of at least three sizes smaller (area under the curve 0.825).Conclusions
Among the factors examined, intertrochanteric BMD showed the strongest association with femoral stem size discrepancy, although it explained only part of the overall variability. Preoperative assessment of intertrochanteric BMD may help anticipate substantial deviations in stem sizing and ensure that appropriately sized implants are available during surgery.
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BibTeX
@article{do2026impact,
title = {{Impact of intertrochanteric bone mineral density on the accuracy of preoperative templating in cementless total hip arthroplasty: a retrospective cohort study of 510 hips.}},
author = {Min Uk Do and Kyeong Baek Kim and Sang-Min Lee and Hyun Tae Koo and Kuen Tak Suh and Won Chul Shin},
journal = {BMC musculoskeletal disorders},
year = {2026},
month = aug,
doi = {10.1186/s12891-026-10301-5},
url = {https://europepmc.org/article/MED/42963545},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of intertrochanteric bone mineral density on the accuracy of preoperative templating in cementless total hip arthroplasty: a retrospective cohort study of 510 hips.
AU - Min Uk Do
AU - Kyeong Baek Kim
AU - Sang-Min Lee
AU - Hyun Tae Koo
AU - Kuen Tak Suh
AU - Won Chul Shin
PY - 2026
DA - 2026/08/04
JO - BMC musculoskeletal disorders
DO - 10.1186/s12891-026-10301-5
UR - https://europepmc.org/article/MED/42963545
AB - Background Preoperative templating accuracy in cementless total hip arthroplasty (THA) may be influenced by patient-specific and radiographic factors, yet bone quality has rarely been considered. We hypothesized that bone mineral density (BMD), and particularly intertrochanteric BMD, would be associated with femoral stem size discrepancy.Methods In a retrospective cohort of 510 hips (467 patients) undergoing primary cementless THA, we compared templated and actual implant sizes for both femoral and acetabular components and assessed clinical and radiographic variables, including age, sex, weight, body mass index, BMD (T-score) at multiple proximal femoral sites, Dorr classification, and surgeon training level, using univariate and multivariable linear regression. Receiver operating characteristic analysis evaluated the discriminative performance of BMD for substantial stem size discrepancies.Results No factor was associated with acetabular cup size discrepancy. Age, weight, and intertrochanteric BMD were independently associated with femoral stem size discrepancy, with intertrochanteric BMD showing the strongest association among the variables examined (standardized β = -0.326). A T-score cutoff of - 0.9 was associated with discrepancies of at least three sizes larger than templated (area under the curve 0.782), and a cutoff of 0.2 with discrepancies of at least three sizes smaller (area under the curve 0.825).Conclusions Among the factors examined, intertrochanteric BMD showed the strongest association with femoral stem size discrepancy, although it explained only part of the overall variability. Preoperative assessment of intertrochanteric BMD may help anticipate substantial deviations in stem sizing and ensure that appropriately sized implants are available during surgery.
SN - 1471-2474
ER -