Background When approaching a joint replacement procedure, pre-surgical planning is essential to predict an accurate estimation of implant size and position. There are currently two methods to achieve it, analog and digital. The present study aims to demonstrate how the hybrid technique is accurate and precise for pre-surgical planning in a non-cemented total hip replacement. Methods Concordance-type study is used against a gold standard, as well as inter- and intra-observer consistency evaluation of two orthopedic surgeons and two orthopedic surgery residents. Accuracy was calculated with the intra-class correlation coefficient (ICC). Afterwards, the same calculation was done considering a margin of error with one size more and one less. Results Thirty-eight patients were included in the study: 19 women and 19 men. Twenty-two prostheses (57.89%) were right-sided and 16 were left (42.11%). Twelve prostheses (31.57%) were Stryker and 26 Johnson & Johnson (68.43%). Acetabular cup correlation compared with the gold standard was moderate: ICC reported 0.45 (95% CI, 0.15–0.76). When adjusted by ± 1 size, ICC was 0.48 (95% CI, 0.18–0.79). On the other hand, results from the femoral stem reported ICC 0.85 (95% CI, 0.07–0.98). When adjusted by ± 1 size, ICC was 0.86 (95% CI, 0.06–0.99). Conclusions Hybrid templating is a reliable substitute for analog or digital planning. It is quick, inexpensive, accurate, and better results are observed in the femoral component regardless the level of expertise of the evaluator. Level of evidence Grade IV

BackgroundPre-surgical planning in joint replacements allows an estimation of the size and position of the potential implant before surgery. Currently, there are two methods to estimate the size and position: Analogue and digital. This study aims to demonstrate that the hybrid technique is accurate and precise in pre-surgical planning of non-cemented Total Hip Replacement. MethodsConcordance-type study against a gold standard, as well as inter and intraobserver consistency evaluation of two orthopedic surgeons and two orthopedic surgery residents. Accuracy was calculated with the intraclass correlation coefficient (ICC), afterwards, the same calculation was done taking into account a margin of error of 1 size above and 1 size below. ResultsThirty-eight patients were included in the study. 19 women and 19 men. 22 prostheses (57.89%) were right-lateralized and 16 left (42.11%). 12 prostheses (31.57%) were Stryker and 26 Johnson & Johnson (68.43%) Acetabular cup correlation compared with the gold standard was moderate: ICC reported 0.45 (95% CI, 0.15-0.76). When adjusted by +/-1 size ICC was 0.48 (95% CI, 0.18-0.79). On the other hand, results from the femoral stem reported: ICC 0.85 (95% CI, 0.07-0.98). When adjusted by +/-1 size ICC was 0.86 (95% CI, 0.06-0.99). ConclusionsHybrid templating is a reliable substitute for analog or digital templating. It is quick and inexpensive; better results are observed in the femoral component. The level of expertise of the evaluator did not affect the accuracy of the planning. Level of evidence: Grade IV

Introduction: Aseptic loosening by mechanical failure is one of the main causes of proximal femur endoprosthesis failure with different clinical consequences such as pain, inflammation, progressive loosening of muscular volume, and strength with functional limitation. Materials and Methods:We present the surgical description of the case of a patient with aseptic loosening of proximal femur endoprosthesis that was treated with a novel technique that combines different methods to achieve primary stability.Discussion: Different surgical techniques have been described to treat aseptic loosening of femoral endoprosthesis, including bone allografts, and total femur prosthesis which provides good functional results but high rates of complications such as infection (13%), dislocation (6%), and material failure (3%).Results: Proximal femur endoprosthesis augmentation with polymethylmethacrylate and condylar plate is a novel surgical technique that allows primary stabilization of the construct, early rehabilitation, improvement of functionality, and no signs of new loosening in a follow-up period of 6 months.

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