Short-term outcome of artificial intelligence-assisted preoperative three-dimensional planning of total hip arthroplasty for developmental dysplasia of the hip compared to traditional surgery

OBJECTIVES

This study aims to assess the short-term outcome of total hip arthroplasty for treating developmental dysplasia of the hip (DDH) using artificial intelligence (AI)-assisted three-dimensional (3D) preoperative planning technology.

PATIENTS AND METHODS

Between January 2020 and July 2022, a total of 61 patients with DDH (31 males, 30 females, mean age: 59.2±10.4 years; range, 35 to 78 years) were retrospectively analyzed. The patients were divided into two groups as those in the observation group of AI-assisted 3D preoperative planning technology (n=34) and the control group of traditional two-dimensional X-ray template planning technology (n=27). Perioperative data of the patients were recorded and analyzed.

RESULTS

All patients were followed for more than one year, and no hip dislocation, aseptic loosening, periprosthetic fracture, periprosthetic infection or revision occurred. The accuracy of the planning was based on the agreement between the preoperative planning model and the intraoperative model. The accuracy of preoperative planning for the acetabular prosthesis and femoral prosthesis in the observation group was significantly higher than in the control group. No statistically significant difference was found in the postoperative abduction (p=0.416) and anteversion (p=0.225) between the groups. In the observation group, 91.2% of the acetabular cups were implanted within the Lewinnek safe zone (66.7% in the control group) and 88.2% were within the Callanan safe zone (63% in the control group). There was a statistically significant difference between the two groups in terms of the postoperative lower-limb length discrepancy (p=0.004), which was significantly improved in both groups compared to preoperative values (p<0.01 for all). The postoperative Harris hip score in both groups was significantly improved compared to preoperative scores (p<0.01); however, there was no statistically significant difference between the two groups (p=0.098).

CONCLUSION

Our study results suggest that AI-assisted 3D preoperative planning is evidently more successful than traditional 2D X-ray template planning for predicting prosthesis size. This method seems to be advantageous in acetabular cup positioning, as well as in lower-limb length restoration.

Accuracy analysis of artificial intelligence-assisted three-dimensional preoperative planning in total hip replacement

OBJECTIVES

This study aims to assess the outcome of total hip arthroplasty (THA) using artificial intelligence (AI)-assisted three-dimensional (3D) preoperative planning technology in terms of predicting prosthesis size, acetabular cup positioning, and lowerlimb length restoration.

PATIENTS AND METHODS

Between January 2020 and July 2022, a total of 161 patients (101 males, 60 females; mean age: 57.6±10.5 years; range, 31 to 80 years) who underwent primary unilateral THA were retrospectively analyzed. The patients were divided into two groups as those who were treated with AI-assisted 3D preoperative planning technology (the observation group, n=95) and patients who were treated with traditional two-dimensional (2D) X-ray template planning technology (the control group, n=66).

RESULTS

The accuracy of the planning was based on the consistency of the preoperative planning and intraoperative models. The difference between the observation group and the control group was statistically significant in terms of the accuracy of the preoperative planning of acetabular prostheses (54% vs. 38%, p=0.048) and femoral prostheses (64% vs. 44%, p=0.011), with both values significantly higher in the observation group. The mean inclination angle, anteversion angle, and limb length discrepancy (LLD) in the observation group were 36.85°±4.82°, 12.10°±5.33°, and 2.18±2.70 mm, respectively, while those in the control group were 35.06°±6.07°, 10.95°±5.09°, and 4.42±3.85 mm, respectively. There was a statistically significant difference between the two groups in terms of inclination angle and LLD (p<0.05 for both), but there was no significant difference in terms of anteversion angle (p>0.05). In the observation group, 86.3% (82/95) of acetabular cups were implanted within the Lewinnek safe zone (72.7% [48/66] in the control group), while 83.2% (79/95) were within the Callanan safe zone (69.7% [46/66] in the control group), with both values higher in the observation group (p<0.05).

CONCLUSION

Overall, AI-assisted 3D preoperative planning is superior to traditional 2D X-ray template planning for predicting prosthesis size, and it also has the advantage in terms of acetabular cup positioning and lower-limb length restoration.

Use of smartphone to improve acetabular component positioning in total hip athroplasty: A comparative clinical study

BACKGROUND

The position of the acetabular cup is important to the outcome of total hip athroplasty (THA). We devised an instrument that uses the level indicator application of smartphone together with a mechanical alignment guide to improve the precision of cup placement. This study aims to determine the percentage of acetabular cups positioned in the Lewinnek safe zone comparing between the conventional technique (using a mechanical alignment guide alone) and the smartphone technique (using a mechanical alignment guide combined with the devised instrument and smartphone).

METHODS

A historical controlled trial was conducted among 82 patients who underwent primary THAs through a posterolateral approach. In the conventional group, 41 cups were placed during January 2013 and December 2014, whereas 41 cups in the smartphone group were placed during January 2015 and March 2016. Inclination and anteversion angles were measured in standardized pelvic radiographs. The cup orientation was compared between groups.

RESULTS

The inclination angle in the smartphone group was significantly lower than in the conventional group (40.9° (SD 3.8) vs. 46.3° (SD 6.7), p < 0.001), but the anteversion angle was higher (19.6° (SD 4.4) vs. 16.5° (SD 6.1), p = 0.010). The smartphone group had more cups positioned in the Lewinnek safe zone (90.2% vs. 56.1%, p = 0.001) and longer operative times (136 (SD 27) vs. 119 (SD 23) min, p = 0.011). No significant difference was found for blood loss ( p== 0.384) or dislocation rate ( p = 0.494).

CONCLUSION

Using the computerized function of smartphone could improve the precision of cup positioning. Most cups were placed within a narrow margin inside the Lewinnek safe zone.