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      Value of 3D preoperative planning for primary total hip arthroplasty based on artificial intelligence technology

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          Abstract

          Background

          Accurate 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.

          Methods

          A 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.

          Results

          The 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).

          Conclusion

          AI HIP showed excellent reliability for component size in THA. Acetabular dysplasia may affect the accuracy of AI HIP templating.

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          Most cited references26

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          Acetabular cup position and risk of dislocation in primary total hip arthroplasty

          Background and purpose — Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA. Methods — A systematic search of literature in the PubMed database was performed (January and February 2016) to identify articles that compared acetabular cup positioning and the risk of dislocation. Surgical approach and methods for measurement of cup angles were also considered. Results— 28 articles were determined to be relevant to our research question. Some articles demonstrated that cup positioning influenced postoperative dislocation whereas others did not. The majority of articles could not identify a statistically significant difference between dislocating and non-dislocating THA with regard to mean angles of cup anteversion and inclination. Most of the articles that assessed cup placement within the Lewinnek safe zone did not show a statistically significant reduction in dislocation rate. Alternative target ranges have been proposed by several authors. Interpretation— The Lewinnek safe zone could not be justified. It is difficult to draw broad conclusions regarding a definitive target zone for cup positioning in THA, due to variability between studies and the likely multifactorial nature of THA dislocation. Future studies comparing cup positioning and dislocation rate should investigate surgical approach separately. Standardized tools for measurement of cup positioning should be implemented to allow comparison between studies.
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            Accuracy of the preoperative planning for cementless total hip arthroplasty. A randomised comparison between three-dimensional computerised planning and conventional templating.

            A high accuracy was recently reported for the three-dimensional (3D) computerised planning of total hip arthroplasty (THA), comparing well with navigation regarding leg length and femoral offset. However, there is no randomised study comparing 3D preoperative planning with conventional 2D templating in terms of accuracy and clinical relevance.
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              Leg length discrepancy after total hip arthroplasty.

              Restoration of hip biomechanics, including femoral offset and leg length are desired goals in performing total hip arthroplasty. Minor leg length discrepancies, less than a centimeter, are common after total hip arthroplasty and usually well tolerated. However in some patients, even these small discrepancies are a source of dissatisfaction. In addition, more significant discrepancies can be a risk factor for nerve injury and are a relatively common cause of litigation. Although leg length discrepancy cannot be eliminated after hip arthroplasty, it can be minimized through a series of steps both preoperatively and intraoperatively. These include physical examination to determine true and apparent leg length, and radiographic evaluation to both assess leg length and to preoperatively template the surgical procedure. Finally, the preoperative plan needs to be executed in the operating room using appropriate intraoperative cues.
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                Author and article information

                Contributors
                cdz@smu.edu.cn
                zhaochang81@126.com
                Journal
                J Orthop Surg Res
                J Orthop Surg Res
                Journal of Orthopaedic Surgery and Research
                BioMed Central (London )
                1749-799X
                24 February 2021
                24 February 2021
                2021
                : 16
                : 156
                Affiliations
                [1 ]GRID grid.413107.0, Department of Orthopedics, Orthopedic Hospital of Guangdong Province, , The Third Affiliated Hospital of Southern Medical University, ; No. 183, Zhongshan Rd West, Guangzhou, 510630 China
                [2 ]GRID grid.413107.0, Department of Quality Management and Evaluation, Orthopedic Hospital of Guangdong Province, , The Third Affiliated Hospital of Southern Medical University, ; Guangzhou, Guangdong China
                Author information
                http://orcid.org/0000-0003-2294-5411
                Article
                2294
                10.1186/s13018-021-02294-9
                7903792
                33627149
                81e8480c-f2b6-4018-9fa5-79f3dbe693ae
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 1 December 2020
                : 10 February 2021
                Funding
                Funded by: the Science and Technology Project of Guangdong Province
                Award ID: 2016B090916003
                Funded by: the Natural Science Foundation of Guangdong Province
                Award ID: 2018030310355
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Surgery
                ai,artificial intelligence,preoperative planning,total hip arthroplasty,tha
                Surgery
                ai, artificial intelligence, preoperative planning, total hip arthroplasty, tha

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