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Purpose <p>Accurate preoperative planning is essential for successful total hip arthroplasty (THA). To minimize radiographic measurement errors, external calibration markers (ECMs) are commonly employed. This systematic review aims to identify the most effective ECM types and their optimal placement for digital preoperative planning in THA.</p> Methods <p>A comprehensive literature search was conducted in accordance with PRISMA guidelines and registered on PROSPERO. Five databases—PubMed, Scopus, Web of Science, ScienceDirect, and TRIP—were queried for studies reporting quantitative data on ECM performance in calibrating supine anteroposterior pelvic radiographs. Study quality was assessed using the JBI Critical Appraisal Tool.</p> Results <p>17 studies met the inclusion criteria, encompassing five ECM types: metallic spheres, coins, disks, dual-scale single markers, and the KingMark™ system. The 25&#xa0;mm metallic sphere was the most frequently used marker, commonly positioned either between the patient’s thighs or lateral to the greater trochanter. Reported mean magnification across studies was 115.5%, with an average implant size prediction accuracy of 75.5%. While the overall methodological quality was acceptable, significant heterogeneity in study design and outcome reporting was observed.</p> Conclusion <p>Spherical markers consistently outperformed coins and disks in calibration accuracy. Dual-marker systems such as KingMark™ demonstrated good reproducibility and appear particularly suitable for clinical environments where standardization is crucial. Placement of ECMs lateral to the greater trochanter, and between the thighs, tended to yield more reliable results, despite occasional practical limitations. Further high-quality, standardized studies are needed to define best practices for radiographic calibration in THA planning.</p>

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Radiographic Calibration Markers in Digital Preoperative Planning for Total Hip Arthroplasty: A Systematic Review of Accuracy and Positioning

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • David Ferreira,
  • Ana Rita Martins,
  • José Rodrigues,
  • Joana Azevedo,
  • Pedro Varanda,
  • Guilherme Correia

摘要

Purpose

Accurate preoperative planning is essential for successful total hip arthroplasty (THA). To minimize radiographic measurement errors, external calibration markers (ECMs) are commonly employed. This systematic review aims to identify the most effective ECM types and their optimal placement for digital preoperative planning in THA.

Methods

A comprehensive literature search was conducted in accordance with PRISMA guidelines and registered on PROSPERO. Five databases—PubMed, Scopus, Web of Science, ScienceDirect, and TRIP—were queried for studies reporting quantitative data on ECM performance in calibrating supine anteroposterior pelvic radiographs. Study quality was assessed using the JBI Critical Appraisal Tool.

Results

17 studies met the inclusion criteria, encompassing five ECM types: metallic spheres, coins, disks, dual-scale single markers, and the KingMark™ system. The 25 mm metallic sphere was the most frequently used marker, commonly positioned either between the patient’s thighs or lateral to the greater trochanter. Reported mean magnification across studies was 115.5%, with an average implant size prediction accuracy of 75.5%. While the overall methodological quality was acceptable, significant heterogeneity in study design and outcome reporting was observed.

Conclusion

Spherical markers consistently outperformed coins and disks in calibration accuracy. Dual-marker systems such as KingMark™ demonstrated good reproducibility and appear particularly suitable for clinical environments where standardization is crucial. Placement of ECMs lateral to the greater trochanter, and between the thighs, tended to yield more reliable results, despite occasional practical limitations. Further high-quality, standardized studies are needed to define best practices for radiographic calibration in THA planning.