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. 2024 Mar 8;19(1):176.
doi: 10.1186/s13018-024-04588-0.

Application and evaluation of artificial intelligence 3D preoperative planning software in developmental dysplasia of the hip

Hongbin Xie #  1   2   3 , Jiafeng Yi #  1   2   3 , Yijian Huang #  2   3   4 , Renwen Guo  2   3 , Yubo Liu  1   2   3 , Xiangpeng Kong  5   6 , Wei Chai  7   8
Affiliations

Application and evaluation of artificial intelligence 3D preoperative planning software in developmental dysplasia of the hip

Hongbin Xie et al. J Orthop Surg Res. .

Abstract

Background: Accurate preoperative planning is crucial for successful total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The aim of this study was to compare the accuracy of an artificial intelligence-assisted three-dimensional (3D) planning system (AIHIP) with two-dimensional templates in predicting acetabular cup size in THA for DDH.

Method: This study retrospectively analyzed image data from 103 DDH patients who had THA between May 2019 and August 2023. AIHIP was used for 3D planning, and two-dimensional (2D) templates were used by two experienced surgeons. Accuracy was assessed by comparing predicted and actual cup sizes, and potential factors affecting accuracy were analyzed, including gender, side, BMI, and dysplasia classification.

Results: AIHIP had higher accuracy in predicting the acetabular cup size compared to the 2D template. Within ± 0 size, AIHIP's accuracy was 84.1%, while the 2D template's was 64.0% (p < 0.05). Within ± 1 size, AIHIP's accuracy was 95.1%, while the 2D template's was 81.1% (p < 0.05). Accuracy was unaffected by gender, side, or BMI but was by DDH classification. In subgroup analysis, AIHIP's mean absolute error (0.21 ± 0.54) was significantly lower than the 2D template's (0.62 ± 0.95) for Crowe II and Crowe III (p < 0.05).

Conclusion: AIHIP is superior to 2D templates in predicting the acetabular cup size accurately for THA in DDH patients. AIHIP may be especially beneficial for Crowe II and III DDH patients, as 2D templates may not accurately predict cup size in these cases.

Keywords: Accuracy; Acetabular cup; Artificial intelligence; Hip dysplasia; Preoperative planning; Total hip arthroplasty.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the preoperative AIHIP system planning
Fig. 2
Fig. 2
Schematic diagram of bone segmentation based on the unique algorithm (G-NET neural network) developed by the AIHIP system
Fig. 3
Fig. 3
Schematic diagram of AIHIP. A 3D reconstruction of the hip joint; B–E Acetabular morphology from different perspectives
Fig. 4
Fig. 4
Schematic diagram of placement of the AI hip joint simulation cup position. A–C Software work interface, simulating cup position. D 3D simulation diagram of acetabular cup position. E–H Acetabular cup from different perspectives
Fig. 5
Fig. 5
Schematic diagram of cup planning by a 2D template. A Standard preoperative anteroposterior X-ray of the pelvis. B Preoperative planning by the 2D template
Fig. 6
Fig. 6
Prediction accuracy of Al and 2D methods
Fig. 7
Fig. 7
Case 1, woman, 54 years old, Crowe I DDH, left. A Standard preoperative anteroposterior X-ray of the pelvis. B Preoperative planning by the 2D template; planning results: Cup size was 50 mm. C Preoperative planning by AIHIP; planning results: Cup size was 50 mm. D Standard postoperative anteroposterior X-ray of the pelvis: Cup size was 50 mm
Fig. 8
Fig. 8
Case 2, woman, 51 years old, Crowe II DDH, left. A Standard preoperative anteroposterior X-ray of the pelvis. B Preoperative planning by the 2D template; planning results: Cup size was 50 mm. C Preoperative planning by AIHIP; planning results: Cup size was 52 mm. D Standard postoperative anteroposterior X-ray of the pelvis: Cup size was 52 mm
Fig. 9
Fig. 9
Case 3, woman, 47 years old, Crowe III DDH, right. A Standard preoperative anteroposterior X-ray of the pelvis. B Preoperative planning by the 2D template; planning results: Cup size was 44 mm (Since the OrthoView software does not have a 44 mm Pinnacle cup, a 44 mm Lima cup was planned by the 2D template preoperatively, but the Pinnacle cup was used intraoperatively). C Preoperative planning by AIHIP; planning results: Cup size was 46 mm. D Standard postoperative anteroposterior X-ray of the pelvis: Cup size was 46 mm
Fig. 10
Fig. 10
Case 4, woman, 35 years old, Crowe IV DDH, right. A Standard preoperative anteroposterior X-ray of the pelvis. B Preoperative planning by the 2D template; planning results: Cup size was 44 mm (Since the OrthoView software does not have a 44 mm Pinnacle cup, a 44 mm Lima cup was planned by the 2D template preoperatively, but the Pinnacle cup was used intraoperatively. C Preoperative planning by AIHIP; planning results: Cup size was 44 mm. D Standard postoperative anteroposterior X-ray of the pelvis: Cup size was 44 mm
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