We prospectively compared the utility and precision of preoperative templating performed in printed films (analogue) with that performed on digital radiographs (digital) in 69 patients undergoing primary total hip replacement. Five patients were excluded when misplacement of the marker resulted in a magnification error greater that 10%; in the remaining patients (64 hips), the cup size was within ± one size in 62 (97%) of the analogue and 52 (81%) of the digital (p = 0.01) plans. The stem size was within ± one size in 63 (98%) of the analogue and 60 (94%) of the digital (p = 0.39) plans. The distance from the proximal corner of the lesser trochanter to the center of the prosthetic head (LTCD) in the analogue differed by 5 mm or more from the digital plan in nine cases (14%). Analogue preoperative planning yielded more predictable results than digital planning, particularly in terms of acetabular component size and LTCD that dictates limb lengthening-shortening. The sources of error were not clearly explained by variations in magnification. Inconsistent positioning of the magnification marker may jeopardise the safe implementation of digital templating.
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