----------------------------------------------------------------------------------------------------------------------------------

The Broach Trial: A Quick and Reliable Way to Confirm the

Level of Femoral Neck Osteotomy During Total Hip
Replacement
Harinder Gakhar, FRCS(ORTH),* Naveed Ahmed, MRCS,* and Peter Lewis, FRCS(ORTH)w

Summary: Patients with a leg-length discrepancy have a significantly

poorer outcome after total hip arthroplasty. We describe a simple and
reliable intraoperative technique in confirming the level of femoral
neck osteotomy using the broach trial.
Key Words: hip templatinghip arthroplastylimb length discrepancy.
(Tech Orthop 2012;27: 275)

BACKGROUND
Patients with a leg-length discrepancy (LLD) have a
significantly poorer outcome after total hip arthroplasty.12 We
describe a simple and reliable intraoperative technique in
confirming the level of femoral neck osteotomy using the
broach trial.

TECHNIQUE
Once the hip is dislocated, the femoral neck osteotomy is
marked using the diathermy according to measurements
established with preoperative templating (Fig. 1). The appro-

FIGURE 2. Broach trial confirmation of osteotomy site with

broach tip corresponding to the centre of rotation of the
femoral head.

priately templated broach and trial neck is constructed and is

placed anteriorly deep to the deep fascia along the shaft of the
femur. The broach/neck junction is placed over the planned
osteotomy (Fig. 2). The tip of the trial should correspond with
the centre of rotation of the arthritic femoral head if both the
neck offset and osteotomy is correct.

DISCUSSION
The use of the broach trial to confirm the femoral neck cut
is a rapid and simple technique to reduce the incidence of LLD.
It is inexpensive and reproducible using standard equipment
required during a total hip replacement. In our experience, used
as an augment to routine preoperative templating3 along with a
suture marker in line with the greater trochanter4 and comparison
with the opposite limb in lateral position, the broach trial to
reduces the risk of a LLD. These preoperative and intraoperative
checks are useful tools in reducing LLD and thus improving
patient outcome after total hip replacement.
REFERENCES
FIGURE 1. Proposed osteotomy site based on templating.

From the *Department of Trauma and Orthopaedics, Prince Charles

Hospital, Merthyr Tydfil Hospital, Wales; and wDepartment of Trauma and
Orthopaedics, Prince Charles and Royal Glamorgan Hospital, South Wales, UK.
The authors declare that they have nothing to disclose.
Reprints: Harinder Gakhar, FRCS(ORTH), Department of Trauma and
Orthopaedics, Prince Charles Hospital, Gurnos, Merthyr Tydfil, Wales
CF47 9DT, UK. E-mail:gul34@yahoo.com.
Copyright r 2012 by Lippincott Williams & Wilkins
ISSN: 0885-9698/12/2704-0275

1. Konyves A, Bannister GC. The importance of leg length discrepancy

after total hip arthroplasty. J Bone Joint Surg Br. 2005;87:155157.
2. Wylde V, Whitehouse SL, Taylor AH, et al. Prevalence and functional
impact of patient-perceived leg length discrepancy after hip replacement.
Int Orthop. 2009;33:905909.
3. Goodman SB, Huene DS, Imrie S. Preoperative templating for the
equalization of leg lengths in total hip arthroplasty. Contemp Orthop.
1992;24:703710.
4. Hossain M, Sinha AK. A technique to avoid leg-length discrepancy in
total hip arthroplasty. Ann R Coll Surg Engl. 2007;89:314315.