Research and application of artificial intelligence based three-dimensional preoperative planning system for total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Dong ^1,2 , LIU Xingyu ^3,4 ^△ , ZHANG Yiling ⁴ , CHEN Jiying ¹ ,  TANG Peifu ¹ ,  CHAI Wei ¹

1. Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, P.R.China;
2. The Medical District South of Beijing, Chinese PLA General Hospital, Beijing, 100071, P.R.China;
3. School of Life Sciences, Tsinghua University, Beijing, 100084, P.R.China;
4. Longwood Valley Medical Technology Co. Ltd., Beijing, 100190, P.R.China;

Corresponding author：

TANG Peifu, Email: pftang301@126.com; CHAI Wei, Email: chaiwei301@163.com

Keywords：

Total hip arthroplasty; artificial intelligence; deep learning; preoperative plan; templating measurement

DOI：

10.7507/1002-1892.202005007

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Objective To develop an artificial intelligence based three-dimensional (3D) preoperative planning system (AIHIP) for total hip arthroplasty (THA) and verify its accuracy by preliminary clinical application.Methods The CT image database consisting of manually segmented CT image series was built up to train the independently developed deep learning neural network. The deep learning neural network and preoperative planning module were assembled within a visual interactive interface—AIHIP. After that, 60 patients (60 hips) with unilateral primary THA between March 2017 and May 2020 were enrolled and divided into two groups. The AIHIP system was applied in the trial group (n=30) and the traditional acetate templating was applied in the control group (n=30). There was no significant difference in age, gender, operative side, and Association Research Circulation Osseous (ARCO) grading between the two groups (P>0.05). The coincidence rate, preoperative and postoperative leg length discrepancy, the difference of bilateral femoral offsets, the difference of bilateral combined offsets of two groups were compared to evaluate the accuracy and efficiency of the AIHIP system.Results The preoperative plan by the AIHIP system was completely realized in 27 patients (90.0%) of the trial group and the acetate templating was completely realized in 17 patients (56.7%) of the control group for the cup, showing significant difference (P<0.05). The preoperative plan by the AIHIP system was completely realized in 25 patients (83.3%) of the trial group and the acetate templating was completely realized in 16 patients (53.3%) of the control group for the stem, showing significant difference (P<0.05). There was no significant difference in the difference of bilateral femoral offsets, the difference of bilateral combined offsets, and the leg length discrepancy between the two groups before operation (P>0.05). The difference of bilateral combined offsets at immediate after operation was significantly less in the trial group than in the control group (t=−2.070, P=0.044); but there was no significant difference in the difference of bilateral femoral offsets and the leg length discrepancy between the two groups (P>0.05).Conclusion Compared with the traditional 2D preoperative plan, the 3D preoperative plan by the AIHIP system is more accurate and detailed, especially in demonstrating the actual anatomical structures. In this study, the working flow of this artificial intelligent preoperative system was illustrated for the first time and preliminarily applied in THA. However, its potential clinical value needs to be discovered by advanced research.

Citation： WU Dong, LIU Xingyu, ZHANG Yiling, CHEN Jiying, TANG Peifu, CHAI Wei. Research and application of artificial intelligence based three-dimensional preoperative planning system for total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1077-1084. doi: 10.7507/1002-1892.202005007 Copy

1.	欧阳晨波, 王浩洋, 孟维锟, 等. SuperPATH 与后外侧入路行人工全髋关节置换术的随机对照研究. 中国修复重建外科杂志, 2018, 32(12): 1500-1506.
2.	张子琦, 王春生, 杨佩, 等. 直接前入路与后入路对人工全髋关节置换术后早期康复的影响比较. 中国修复重建外科杂志, 2018, 32(3): 329-333.
3.	杨涛, 谢杰, 胡懿郃, 等. 354 例 Ribbed 股骨柄假体置换术的中远期疗效分析. 中国修复重建外科杂志, 2019, 33(9): 1116-1120.
4.	Singh V, Zak S, Schwarzkopf R, et al. Forgotten joint score in THA: comparing the direct anterior approach to posterior approach. J Arthroplasty, 2020. https://doi.org/10.1016/j.arth.2020.04.074.
5.	Kong XP, Chai W, Yang MZ, et al. Modular stem in total hip arthroplasty for patients with trochanter valgus deformity: surgical technique and case series. BMC Musculoskelet Disord, 2020, 21(1): 124.
6.	杨伟, 曹正, 杨敏之, 等. 数字化模板计划在直接前方入路人工全髋关节置换术中的应用研究. 中国修复重建外科杂志, 2019, 33(11): 1374-1378.
7.	张国栋, 杨晨, 杨光, 等. 全髋关节置换术中不同颈干角股骨假体对股骨近端解剖重建的比较研究. 中国修复重建外科杂志, 2016, 30(1): 30-34.
8.	Healy WL, Iorio R, Clair AJ, et al. Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by the hip society. Clin Orthop Relat Res, 2016, 474(2): 357-364.
9.	Huppertz A, Radmer S, Asbach P, et al. Computed tomography for preoperative planning in minimal-invasive total hip arthroplasty: radiation exposure and cost analysis. Eur J Radiol, 2011, 78(3): 406-413.
10.	刘雯薇, 杨静, 袁素维, 等. 单病种质量控制前后髋关节置换术住院患者的住院日和住院费用评价. 中国卫生统计, 2016, 33(2): 106-108, 111.
11.	Li X, Feng YF, Wang CT, et al. Evaluation of biological properties of electron beam melted Ti6Al4V implant with biomimetic coating in vitro and in vivo. PLoS One, 2012, 7(12): e52049.
12.	Goodfellow I, Bengio Y, Courville A. Deep learning (Vol.1). Cambridge: MIT Press, 2016: 1-787.
13.	Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg (Am), 1995, 77(3): 459-474.
14.	Dastane M, Dorr LD, Tarwala R, et al. Hip offset in total hip arthroplasty: quantitative measurement with navigation. Clin Orthop Relat Res, 2011, 469(2): 429-436.
15.	Archibeck MJ, Cummins T, Tripuraneni KR, et al. Inaccuracies in the use of magnification markers in digital hip radiographs. Clin Orthop Relat Res, 2016, 474(8): 1812-1817.
16.	Weber M, Woerner ML, Springorum HR, et al. Plain radiographs fail to reflect femoral offset in total hip arthroplasty. J Arthroplasty, 2014, 29(8): 1661-1665.
17.	Tsai TY, Dimitriou D, Li G, et al. Does total hip arthroplasty restore native hip anatomy? three-dimensional reconstruction analysis. Int Orthop, 2014, 38(8): 1577-1583.
18.	Nakamura N, Nishii T, Kitada M, et al. Application of computed tomography-based navigation for revision total hip arthroplasty. J Arthroplasty, 2013, 28(10): 1806-1810.
19.	Strom NJ, Pripp AH, Reikerås O. Templating in uncemented total hip arthroplasty-on intra- and interobserver reliability and professional experience. Ann Transl Med, 2017, 5(3): 44.
20.	Hawker GA. Who, when, and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol, 2006, 18(5): 526-530.
21.	Wako Y, Nakamura J, Miura M, et al. Interobserver and intraobserver reliability of three-dimensional preoperative planning software in total hip arthroplasty. J Arthroplasty, 2018, 33(2): 601-607.
22.	Sariali E, Mouttet A, Pasquier G, et al. Three-dimensional hip anatomy in osteoarthritis. Analysis of the femoral offset. J Arthroplasty, 2009, 24(6): 990-997.
23.	Sariali E, Mauprivez R, Khiami F, et al. Accuracy of the preoperative planning for cementless total hip arthroplasty. A randomised comparison between three-dimensional computerised planning and conventional templating. Orthop Traumatol Surg Res, 2012, 98(2): 151-158.
24.	Odri GA, Padiolleau GB, Gouin FT. Oversized cups as a major risk factor of postoperative pain after total hip arthroplasty. J Arthroplasty, 2014, 29(4): 753-756.
25.	Streit MR, Innmann MM, Merle C, et al. Long-term (20- to 25-year) results of an uncemented tapered titanium femoral component and factors affecting survivorship. Clin Orthop Relat Res, 2013, 471(10): 3262-3269.
26.	Robinson M, Bornstein L, Mennear B, et al. Effect of restoration of combined offset on stability of large head THA. Hip Int, 2012, 22(3): 248-253.
27.	Mahmood SS, Mukka SS, Crnalic S, et al. Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength. A prospective cohort study of 222 patients. Acta Orthop, 2016, 87(1): 36-41.
28.	Sheha ED, Steinhaus ME, Kim HJ, et al. Leg-length discrepancy, functional scoliosis, and low back pain. JBJS Rev, 2018, 6(8): e6.
29.	Jabłonski M, Posturzyńska A, Gorzelak M, et al. Problem and tolerance of leg lengthening after total hip replacement. Chir Narzadow Ruchu Ortop Pol, 2008, 73(6): 351-354.
30.	吴东, 尹济琛, 卢江枫, 等. 个性化定制手术导板在全髋关节置换术中的应用. 骨科, 2019, 10(5): 372-378.

1. 欧阳晨波, 王浩洋, 孟维锟, 等. SuperPATH 与后外侧入路行人工全髋关节置换术的随机对照研究. 中国修复重建外科杂志, 2018, 32(12): 1500-1506.
2. 张子琦, 王春生, 杨佩, 等. 直接前入路与后入路对人工全髋关节置换术后早期康复的影响比较. 中国修复重建外科杂志, 2018, 32(3): 329-333.
3. 杨涛, 谢杰, 胡懿郃, 等. 354 例 Ribbed 股骨柄假体置换术的中远期疗效分析. 中国修复重建外科杂志, 2019, 33(9): 1116-1120.
4. Singh V, Zak S, Schwarzkopf R, et al. Forgotten joint score in THA: comparing the direct anterior approach to posterior approach. J Arthroplasty, 2020. https://doi.org/10.1016/j.arth.2020.04.074.
5. Kong XP, Chai W, Yang MZ, et al. Modular stem in total hip arthroplasty for patients with trochanter valgus deformity: surgical technique and case series. BMC Musculoskelet Disord, 2020, 21(1): 124.
6. 杨伟, 曹正, 杨敏之, 等. 数字化模板计划在直接前方入路人工全髋关节置换术中的应用研究. 中国修复重建外科杂志, 2019, 33(11): 1374-1378.
7. 张国栋, 杨晨, 杨光, 等. 全髋关节置换术中不同颈干角股骨假体对股骨近端解剖重建的比较研究. 中国修复重建外科杂志, 2016, 30(1): 30-34.
8. Healy WL, Iorio R, Clair AJ, et al. Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by the hip society. Clin Orthop Relat Res, 2016, 474(2): 357-364.
9. Huppertz A, Radmer S, Asbach P, et al. Computed tomography for preoperative planning in minimal-invasive total hip arthroplasty: radiation exposure and cost analysis. Eur J Radiol, 2011, 78(3): 406-413.
10. 刘雯薇, 杨静, 袁素维, 等. 单病种质量控制前后髋关节置换术住院患者的住院日和住院费用评价. 中国卫生统计, 2016, 33(2): 106-108, 111.
11. Li X, Feng YF, Wang CT, et al. Evaluation of biological properties of electron beam melted Ti6Al4V implant with biomimetic coating in vitro and in vivo. PLoS One, 2012, 7(12): e52049.
12. Goodfellow I, Bengio Y, Courville A. Deep learning (Vol.1). Cambridge: MIT Press, 2016: 1-787.
13. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg (Am), 1995, 77(3): 459-474.
14. Dastane M, Dorr LD, Tarwala R, et al. Hip offset in total hip arthroplasty: quantitative measurement with navigation. Clin Orthop Relat Res, 2011, 469(2): 429-436.
15. Archibeck MJ, Cummins T, Tripuraneni KR, et al. Inaccuracies in the use of magnification markers in digital hip radiographs. Clin Orthop Relat Res, 2016, 474(8): 1812-1817.
16. Weber M, Woerner ML, Springorum HR, et al. Plain radiographs fail to reflect femoral offset in total hip arthroplasty. J Arthroplasty, 2014, 29(8): 1661-1665.
17. Tsai TY, Dimitriou D, Li G, et al. Does total hip arthroplasty restore native hip anatomy? three-dimensional reconstruction analysis. Int Orthop, 2014, 38(8): 1577-1583.
18. Nakamura N, Nishii T, Kitada M, et al. Application of computed tomography-based navigation for revision total hip arthroplasty. J Arthroplasty, 2013, 28(10): 1806-1810.
19. Strom NJ, Pripp AH, Reikerås O. Templating in uncemented total hip arthroplasty-on intra- and interobserver reliability and professional experience. Ann Transl Med, 2017, 5(3): 44.
20. Hawker GA. Who, when, and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol, 2006, 18(5): 526-530.
21. Wako Y, Nakamura J, Miura M, et al. Interobserver and intraobserver reliability of three-dimensional preoperative planning software in total hip arthroplasty. J Arthroplasty, 2018, 33(2): 601-607.
22. Sariali E, Mouttet A, Pasquier G, et al. Three-dimensional hip anatomy in osteoarthritis. Analysis of the femoral offset. J Arthroplasty, 2009, 24(6): 990-997.
23. Sariali E, Mauprivez R, Khiami F, et al. Accuracy of the preoperative planning for cementless total hip arthroplasty. A randomised comparison between three-dimensional computerised planning and conventional templating. Orthop Traumatol Surg Res, 2012, 98(2): 151-158.
24. Odri GA, Padiolleau GB, Gouin FT. Oversized cups as a major risk factor of postoperative pain after total hip arthroplasty. J Arthroplasty, 2014, 29(4): 753-756.
25. Streit MR, Innmann MM, Merle C, et al. Long-term (20- to 25-year) results of an uncemented tapered titanium femoral component and factors affecting survivorship. Clin Orthop Relat Res, 2013, 471(10): 3262-3269.
26. Robinson M, Bornstein L, Mennear B, et al. Effect of restoration of combined offset on stability of large head THA. Hip Int, 2012, 22(3): 248-253.
27. Mahmood SS, Mukka SS, Crnalic S, et al. Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength. A prospective cohort study of 222 patients. Acta Orthop, 2016, 87(1): 36-41.
28. Sheha ED, Steinhaus ME, Kim HJ, et al. Leg-length discrepancy, functional scoliosis, and low back pain. JBJS Rev, 2018, 6(8): e6.
29. Jabłonski M, Posturzyńska A, Gorzelak M, et al. Problem and tolerance of leg lengthening after total hip replacement. Chir Narzadow Ruchu Ortop Pol, 2008, 73(6): 351-354.
30. 吴东, 尹济琛, 卢江枫, 等. 个性化定制手术导板在全髋关节置换术中的应用. 骨科, 2019, 10(5): 372-378.

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Research and application of artificial intelligence based three-dimensional preoperative planning system for total hip arthroplasty

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