| Objective: This research explores the accuracy of predicting prosthesis size with AI computer-aided three-dimensional preoperative planning technology for total hip arthroplasty(THA),compared it with traditional two-dimensional X-ray film template preoperative planning technology to analyze the factors affecting the accuracy,so as to provide bases for the popularization and improvement of AI computer-assisted threedimensional preoperative planning in the field of THA.Methods: From October 2019 to November 2020,80 patients who underwent primary THA in the first affiliated hospital of Dalian Medical University were prospectively included in this research.The general information(age,gender,body mass index,classification of American Society of Anesthesiology,diagnosis,medical complications)and perioperative information(left and right sides of the operation,Dorr classification of proximal femoral medullary cavity,application of acetabular screws during operation,location of femoral prosthesis in medullary cavity after operation)were collected.AI computer-aided 3D planning and traditional X-ray film 2D template planning were carried out on the same patient before surgery.This research compared the planned size with the actual prosthesis size,and analyzed the difference of accuracy between AI 3D planning and 2D X-ray film planning.The influencing factors were also studied.There were 35 males and 45 females with an average age of 61.7 years(29-79 years).There were 28 cases of femoral head necrosis,20 cases of osteoarthritis,18 cases of femoral neck fracture and 14 cases of developmental dysplasia of hip.There were 34 patients suffer from medical diseases(hypertension and / or diabetes)before operation.There were 39 cases on the left side and 41 cases on the right side.The medullary cavity of the proximal femur had 9 cases of Dorr A type,61 cases of Dorr B type,and 10 cases of Dorr C type.During the operation,the prosthesis was stable and reliable,the motion of hip joint recovered well.Postoperative evaluation of prosthesis position was acceptable,no loosening or sinking was seen in the early stage,and there was no adverse outcome in regular follow-up.Results:(1)The accuracy of planning was based on the consistency of preoperative planning model and intraoperative model.The accuracy of AI three-dimensional preoperative planning of acetabular prosthesis was 56.25%,that of X-ray film was33.75%.The accuracy of AI three-dimensional preoperative planning of femoral prosthesis was 55.00%,and that of X-ray film was 36.25%.The accuracy of AI threedimensional preoperative planning was higher than two-dimensional X-ray film in predicting the type of prosthesis,and the difference was statistically significant(acetabular side p< 0.05,femoral side p< 0.05).(2)Two methods have a certain degree of consistency in predicting the type of femoral prosthesis(p< 0.05,Kappa coefficient =0.246).The consistency of two methods in predicting the type of acetabular prosthesis is poor(p> 0.05,Kappa coefficient = 0.087).Compared with the actual application model,the ICC value of X-ray two-dimensional planning is 0.720(p< 0.001),AI threedimensional planning is 0.795(p< 0.001).AI 3D planning of acetabular prosthesis is better than X-ray 2D planning.However,when the AI planning is not accurate,the deviation of the planned model is larger than the actual application model.(3)Age is a risk factor affecting the results of X-ray 2D planning(acetabular side p< 0.05,femoral side p< 0.05).With the increase of age,the accuracy of X-ray 2D planning for prosthesis planning decreases gradually.Placing the femoral handle in a non-neutral position is more likely to lead to the discrepancy between the actual application size of the femoral handle and the results of AI 3D planning(p<0.05).Conclusions: AI 3D preoperative planning is better than 2D X-ray preoperative planning in predicting prosthesis size,AI’s predicting result is more consistent with the actual application model,especially in acetabular side.The traditional planning technology is greatly influenced by age.AI 3D preoperative planning technology shows excellent stability and repeatability,can be widely used.With the improvement of planning accuracy,the requirements for surgeons’ surgical techniques have also increased.Accurate placement will bring better results. |
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