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Objective  This study aims to compare the accuracy of CT‐based preoperative planning with that of acetate templating in predicting implant size, neck length, and neck cut length, and to evaluate the reproducibility of the two methods.    Methods  This prospective study was conducted between August 2020 and March 2021. Patients who underwent elective primary total hip arthroplasty by a single surgeon were assessed for eligibility. The included patients underwent both acetate templating and CT‐based planning by two observers after the operation. Each observer conducted both acetate templating and CT‐based planning twice for each case. The outcome measures included the following: (1) the accuracy of surgical planning in predicting implant size, calcar length, and neck length, which was defined as the difference between the planned size and length and the actual size and length; (2) reproducibility of the two planning techniques, which were assessed by inter‐observer and intra‐observer reliability analysis; (3) the influence of potential confounding factors on planning accuracy, which was evaluated using generalized estimating equations.    Results  A total of 57 cases were included in the study. CT‐based planning was more accurate than acetate templating for predicting cup size (93%  vs  79%,  p  < 0.001) and stem size (93%  vs  75%,  p  < 0.001). When assessed by mean absolute difference, the comparison between acetate templating and CT‐based planning was 4.28 mm  vs  3.74 mm ( p  = 0.122) in predicting neck length and 3.05 mm  vs  2.93 mm ( p  = 0.731) in predicting neck cut length. In the inter‐observer reliability analysis, an intraclass correlation coefficient (ICC) of 0.790 was achieved for predicting cup size, and an ICC of 0.966 was achieved for predicting stem size using CT‐based planning. In terms of intra‐observer reliability, Observer 1 achieved an ICC of 0.803 for predicting cup size and 0.965 for predicting stem size in CT‐based planning. Observer 2 achieved ICC values of 0.727 and 0.959 for predicting cup and stem sizes, respectively. The average planning time was 6.48 ± 1.55 min for CT‐based planning and 6.12 ± 1.40 min for acetate templating ( p  = 0.015).    Conclusion  The CT‐based planning system is more accurate than acetate templating for predicting implant size and has good reproducibility in total hip arthroplasty.

Validation of CT ‐Based Three‐Dimensional Preoperative Planning in Comparison with Acetate Templating for Primary Total Hip Arthroplasty