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Chen CC, Huang JF, Lin WC, Cheng CT, Chen SC, Fu CY, Lee MS, Liao CH, Chung CY. The Feasibility and Performance of Total Hip Replacement Prediction Deep Learning Algorithm with Real World Data. Bioengineering (Basel) 2023; 10:bioengineering10040458. [PMID: 37106645 PMCID: PMC10136253 DOI: 10.3390/bioengineering10040458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Hip degenerative disorder is a common geriatric disease is the main causes to lead to total hip replacement (THR). The surgical timing of THR is crucial for post-operative recovery. Deep learning (DL) algorithms can be used to detect anomalies in medical images and predict the need for THR. The real world data (RWD) were used to validate the artificial intelligence and DL algorithm in medicine but there was no previous study to prove its function in THR prediction. (2) Methods: We designed a sequential two-stage hip replacement prediction deep learning algorithm to identify the possibility of THR in three months of hip joints by plain pelvic radiography (PXR). We also collected RWD to validate the performance of this algorithm. (3) Results: The RWD totally included 3766 PXRs from 2018 to 2019. The overall accuracy of the algorithm was 0.9633; sensitivity was 0.9450; specificity was 1.000 and the precision was 1.000. The negative predictive value was 0.9009, the false negative rate was 0.0550, and the F1 score was 0.9717. The area under curve was 0.972 with 95% confidence interval from 0.953 to 0.987. (4) Conclusions: In summary, this DL algorithm can provide an accurate and reliable method for detecting hip degeneration and predicting the need for further THR. RWD offered an alternative support of the algorithm and validated its function to save time and cost.
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Affiliation(s)
- Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Jen-Fu Huang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Wei-Cheng Lin
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
- Department of Electrical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Shann-Ching Chen
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Mel S Lee
- Department of Orthopaedic Surgery, Pao-Chien Hospital, Pingtung 90078, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
| | - Chia-Ying Chung
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan 33328, Taiwan
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Hill AM, Ross-Adjie G, McPhail SM, Jacques MBiostat A, Bulsara M, Cranfield A, Etherton-Beer C, Azlan Mn NR, Powell SJ, Hardisty G, Monterosso L. Incidence and Associated Risk Factors for Falls in Older Adults After Elective Total Knee Replacement Surgery: A Prospective Cohort Study. Am J Phys Med Rehabil 2022; 101:454-459. [PMID: 34292196 DOI: 10.1097/phm.0000000000001848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 mos after elective, primary total knee replacement surgery. DESIGN A prospective observational cohort of older adults undergoing total knee replacement were followed. Baseline measurements included risk factors of history of falls, using a gait aid and number of medications. Falls data were recorded after discharge for 12 mos alongside patient reported outcomes (Oxford Knee Score). Analyses used logistic and negative binomial regression modeling. RESULTS There were 267 participants (mean age = 70 [6.7] yrs) enrolled. Participants who fell (n = 102 [40.6%]) reported 200 falls in the 12 mos after surgery. The incidence of falls was 2.4 falls per 1000 patient days in the 12 mos after surgery, with the highest incidence (2.6 falls per 1000 patient days) in month 1. Risk factors for falling were a history of falls (adjusted odds ratio = 2.41, 95% confidence interval = 1.35-4.31) and number of central nervous system acting medications taken before surgery (adjusted odds ratio = 1.66, 95% confidence interval = 1.25-2.21). Using a walking aid at baseline was associated with falls after discharge (adjusted incident rate ratio = 2.38, 95% confidence interval = 1.57-3.60). CONCLUSIONS Older adults experience a high incidence of falls after elective total knee replacement. Further research that investigates falls prevention after total knee replacement is required.
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Affiliation(s)
- Anne-Marie Hill
- From the School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia (A-MH, AJ); Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia (A-MH, MB); School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Australia (GR-A, LM); Australian Centre for Health Services Innovation and Centre of Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia (SMM); Clinical Informatics Directorate, Metro South Health, Brisbane, Australia (SMM); Centre for Nursing and Midwifery Research, St John of God Hospital, Murdoch, Australia (AC, NRA, S-JP, LM); WA Centre for Health and Ageing, University of Western Australia, Perth, Australia (CE-B); Faculty of Health and Medical Sciences: Surgery, University of Western Australia, Perth, Australia (GH); Western Orthopaedic Clinic, St John of God Hospital Murdoch and Hollywood, Perth, Australia (GH); School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia (LM); and Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia (LM)
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Laskow T, Zhu J, Buta B, Oni J, Sieber F, Bandeen-Roche K, Walston J, Franklin PD, Varadhan R. Risk Factors for Non-Resilient Outcomes in Older Adults after Total Knee Replacement in the FORCE-TJR Cohort. J Gerontol A Biol Sci Med Sci 2021; 77:1915-1922. [PMID: 34480562 DOI: 10.1093/gerona/glab257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Total knee replacement (TKR) is a common procedure in older adults. Physical resilience may be a useful construct to explain variable outcomes. We sought to define a simple measure of physical resilience and identify risk factors for non-resilient patient outcomes. METHODS Secondary analysis of FORCE-TJR cohort study, a prospective registry of total joint replacement. Analysis included 7,239 adults ages 60 or older who underwent TKR between 2011- 2015. Measures included sociodemographic and health factors. Outcomes were categorized as physically resilient versus non-resilient based on the change from baseline to 1-year follow up for three patient-reported outcomes: the physical component summary (PCS), bodily pain (BP), and vitality (VT) from the Short Form-36 (SF-36) subcomponent scores, at pre-op and 1-year post-procedure. Associations were expressed as relative risk of physically non-resilient outcomes using generalized linear regression models, with Poisson distribution and log link. RESULTS Age, BMI, and Charlson Comorbidity Index (CCI) were associated with increased risk of physically non-resilient outcomes across PCS, BP, and VT: age, per 5-years for PCS (RR=1.18[1.12-1.23]), BP (RR=1.06[1.01-1.11), and VT (RR=1.09[1.06-1.12]); BMI, per 5 Kg/m 2, for PCS (RR=1.13[1.07-1.19]), BP (RR=1.06[1.00-1.11]), and VT (RR=1.08[1.04-1.11]); and CCI for PCS CCI=1 (RR=1.38[1.20-1.59]), CCI=2-5 (RR=1.59[1.35-1.88]), CCI>=6 (RR=1.55[1.31-1.83]. Household-income >$45,000 associated with lower risk for PCS (RR=0.81[0.70-0.93]), BP (RR=0.80[0.69-0.91],), and VT (RR=0.86[0.78-0.93]). CONCLUSIONS We operationalized physical resilience and identified factors predicting resilience after TKR. This approach may aid clinical risk stratification, guide further investigation of causes, and ultimately aid patients through the design of interventions to enhance physical resilience.
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Affiliation(s)
- Thomas Laskow
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jiafeng Zhu
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brian Buta
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julius Oni
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Frederick Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Karen Bandeen-Roche
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patricia D Franklin
- Institute for Public Health and Medicine at Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
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Hill AM, Ross-Adjie G, McPhail SM, Jacques A, Bulsara M, Cranfield A, Etherton-Beer C, Azlan NR, Powell SJ, Hardisty G, Monterosso L. Incidence and Associated Risk Factors for Falls in Older Adults Postdischarge Who Undergo Elective Total Hip Replacement Surgery—A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2020; 76:1814-1820. [DOI: 10.1093/gerona/glaa283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Indexed: 12/22/2022] Open
Abstract
Abstract
Background
Hip replacement surgery improves health-related quality of life; however, it has been suggested that falls rates increase after hospital discharge. The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 months after undergoing elective total hip replacement surgery.
Methods
A prospective observational cohort study was conducted. Participants were adults aged 60 years or older who underwent primary elective total hip replacement surgery in a private tertiary hospital in Perth, Australia. Baseline data collected immediately prior to discharge included use of walking aids, medications, and functional level of independence (using Katz and Lawton scales). Falls data were collected for 12 months using calendars and monthly phone calls. Data were analyzed using logistic and negative binomial regression modeling.
Results
Participants’ ([n = 167], 54.4% female) mean age was 71.2 (±6.9) years. There were 51 (31%) participants who used a walking aid prior to surgery. There were 140 falls reported over 12 months by 67 (42%) participants, of which 90 (64.3%) were injurious (n = 9 fractures). The fall rate was 2.6 per 1000 patient-days. Age (adjusted odds ratio 1.10, 95% confidence interval 1.01–1.20) and hospital length of stay (adjusted odds ratio 1.24, 95% confidence interval 1.00–1.54).were significantly associated with sustaining multiple falls.
Conclusions
More than 40% of older adults fell in the 12 months after elective hip replacement surgery although the cohort had low fall risk prior to surgery. Rehabilitation after hip replacement surgery should consider fall prevention.
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Affiliation(s)
- Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | - Gail Ross-Adjie
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre of Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Clinical Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Angela Jacques
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | - Alexis Cranfield
- Centre for Nursing and Midwifery Research, St John of God Hospital, Murdoch, Australia
| | | | - Natasya Raja Azlan
- Centre for Nursing and Midwifery Research, St John of God Hospital, Murdoch, Australia
| | - Sarah-Jayne Powell
- Centre for Nursing and Midwifery Research, St John of God Hospital, Murdoch, Australia
| | - Gerard Hardisty
- Faculty of Health and Medical Sciences: Surgery, University of Western Australia, Perth, Australia
- Western Orthopaedic Clinic, St John of God Hospital Murdoch and Hollywood, Perth, Australia
| | - Leanne Monterosso
- School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Australia
- Centre for Nursing and Midwifery Research, St John of God Hospital, Murdoch, Australia
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