Abstract
BackgroundAccurate preoperative planning is an important step for accurate reconstruction in total hip arthroplasty (THA). Presently, preoperative planning is completed using either a two-dimensional (2D) template or three-dimensional (3D) mimics software. With the development of artificial intelligence (AI) technology, AI HIP, a planning software based on AI technology, can quickly and automatically identify acetabular and femur morphology, and automatically match the optimal prosthesis size. However, the accuracy and feasibility of its clinical application still needs to be further verified. The purposes of this study were to investigate the accuracy and time efficiency of AI HIP in preoperative planning for primary THA, compared with 3D mimics software and 2D digital template, and further analyze the factors that influence the accuracy of AI HIP.MethodsA prospective study was conducted on 53 consecutive patients (59 hips) undergoing primary THA with cementless prostheses in our department. All preoperative planning was completed using AI HIP as well as 3D mimics and 2D digital template. The predicted component size and the actual implantation results were compared to determine the accuracy. The templating time was compared to determine the efficiency. Furthermore, the potential factors influencing the accuracy of AI HIP were analyzed including sex, body mass index (BMI), and hip dysplasia.ResultsThe accuracy of predicting the size of acetabular cup and femoral stem was 74.58% and 71.19%, respectively, for AI HIP; 71.19% (P = 0.743) and 76.27% (P = 0.468), respectively, for 3D mimics; and 40.68% (P < 0.001) and 49.15% (P = 0.021), respectively, for 2D digital templating. The templating time using AI HIP was 3.91 ± 0.64 min, which was equivalent to 2D digital templates (2.96 ± 0.48 min, P < 0.001), but shorter than 3D mimics (32.07 ± 2.41 min, P < 0.001). Acetabular dysplasia (P = 0.021), rather than sex and BMI, was an influential factor in the accuracy of AI HIP templating. Compared to patients with developmental dysplasia of the hip (DDH), the accuracy of acetabular cup in the non-DDH group was better (P = 0.021), but the difference in the accuracy of the femoral stem between the two groups was statistically insignificant (P = 0.062).ConclusionAI HIP showed excellent reliability for component size in THA. Acetabular dysplasia may affect the accuracy of AI HIP templating.
Highlights
Accurate preoperative planning is an important step for accurate reconstruction in total hip arthroplasty (THA)
Acetabular dysplasia may affect the accuracy of artificial intelligence (AI) HIP templating
To achieve rapid planning and avoid planning deviation caused by personal experience is the key problem to be solved in preoperative planning
Summary
Accurate preoperative planning is an important step for accurate reconstruction in total hip arthroplasty (THA). When the prosthesis is improperly selected, it will lead to a series of intraoperative and postoperative complications, such as leg length discrepancy [1], joint dislocation [2], periprosthetic fracture [3], aspetic loosening [4, 5], and stress-shielding [6, 7] This will lead to an increase in the revision rate, resulting in patient dissatisfaction and lower clinical score. Holzer et al [13] conducted a retrospective study on 632 patients using a digital template, and the complete accuracy rate of predicting acetabular cup and femoral stem was 37% and 42%, respectively. Sariali et al [16] used 3D software for preoperative planning of 30 patients receiving THA, and the accuracy of predicting one size of the femoral stem and acetabular cup was 100% and 96%, respectively. The complete accuracies of acetabular cup and femoral stem were 92% and 65%, respectively, and the accuracy rate of one acetabular cup and femoral stem was 100% and 98%, respectively
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