Hip arthroplasty is a frequently used procedure with high success rates. Its main indications are primary or secondary advanced osteoarthritis, due to acute fracture, osteonecrosis of the femoral head, and hip dysplasia. The goals of HA are to reduce pain and restore normal hip biomechanics, allowing a return to the patient’s normal activities. To reach those goals, the size of implants must suit, and their positioning must meet, quality criteria, which can be determined by preoperative imaging. Moreover, mechanical complications can be influenced by implant size and position, and could be avoided by precise preoperative templating. Templating used to rely on standard radiographs, but recently the use of EOS® imaging and CT has been growing, given the 3D approach provided by these methods. However, there is no consensus on the optimal imaging work-up, which may have an impact on the outcomes of the procedure. This article reviews the current principles of templating, the various imaging techniques used for it, as well as their advantages and drawbacks, and their expected results.

Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s characteristics, and the surgical approach. Radiographs are still the first imaging modality used for routine follow-up, in asymptomatic and painful cases. CT and MRI used to suffer from metallic artifacts but are nowadays central in HA complications diagnosis, both having their advantages and drawbacks. Additionally, there is no consensus on the optimal imaging workup for HA complication diagnosis, which may have an impact on patient management. After a brief reminder about the different types of prostheses, this article reviews their normal and pathologic appearance, according to each imaging modality, keeping in mind that few abnormalities might be present, not anyone requiring treatment, depending on the clinical scenario. A diagnostic imaging workup is also discussed, to aid the therapist in his imaging studies prescription and the radiologist in their practical aspects.

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