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This study proposes a novel artificial intelligence preoperative planning approach based on expert surgical case database retrieval in revision hip arthroplasty. Additionally, the technique was initially employed in five patients, exhibiting a reduction in operative time and intraoperative hemorrhage.
Accurate preoperative planning in revision hip arthroplasty is crucial for achieving successful outcomes. To enhance the intuitive evaluation of acetabular bone defect severity and leverage previous successful experience in revision hip arthroplasty, this study proposes a novel approach based on expert surgical case database retrieval and is initially implemented in clinical application. In this study, five patients who required revision hip arthroplasty were preoperatively planned to employ the expert case database surgical planning system.The patient's imaging data was entered into the system and matched with cases in the expert case database. Based on the expert's surgical experience, a revision surgery plan was recommended. If no suitable case was found, the model and position of the prosthesis were planned based on patient-specific reconstruction results. A total of five patients were enrolled in this study, four males and one female, with a mean age of 50.6 years. The diagnosis was aseptic prosthesis loosening after hip arthroplasty. The mean operative time was 123.2 min, and the mean intraoperative hemorrhage was 672 mL. No intraoperative complications, such as vascular or nerve injury, were observed. In Case 2, for instance, the application of this innovative planning scheme enabled the surgeon to delineate the revision surgery plan for this patient in the preoperative period, thereby reducing the operative time and intraoperative hemorrhage. Furthermore, patients could be apprised of the outcomes of analogous cases in advance. Leveraging a big data analysis approach through our comprehensive case database enables automated identification of matching expert treatment plans throughout the entire process. This particularly benefits inexperienced orthopedic surgeons by providing accurate guidance on surgical strategies to assist them in selecting appropriate prosthetic sizes and mounting positions. Additionally, the matching results can offer patients visualizations depicting predicted postoperative outcomes.
The increasing prevalence of primary total hip arthroplasty (THA) has led to a corresponding rise in the necessity for revision arthroplasty due to a number of factors, including aseptic loosening, infection, recurrent dislocation, and periprosthetic fracture1. Compared to primary hip arthroplasty, revision hip surgery is a more technically complex and clinically challenging procedure, with higher mortality rates2, higher healthcare costs3, and greater complication risks4.
In revision hip arthroplasty, the reconstruction of acetabular bone loss and the selection of prosthesis are paramount in determining the success of the surgery. The orthopedic surgeon needs to assess the residual bone stock and the altered anatomy, aiming for adequate initial stability of the newly implanted acetabular cup1. Consequently, precise preoperative planning is crucial to guide available treatment options.
Currently, orthopedic surgeons are responsible for conducting a comprehensive assessment and planning of revision arthroplasty based on preoperative imaging findings and their own surgical experience. Nevertheless, this will present a significant challenge for the inexperienced surgeon.
With the development of artificial intelligence (AI) technology, it has been increasingly used in orthopedic surgery, primarily for image segmentation, diagnosis, and classification of pathologies and implants5. Meanwhile, AI is beginning to achieve initial success in assisting primary THA6. However, intelligent preoperative planning for revision hip arthroplasty remains a blank slate. AI has a promising future in hip revision surgery, particularly in the assessment of bone defects. These defects are unique to each patient, and while they exhibit certain patterns, the traditional Paprosky classification method lacks the precision required to fully characterize them. Nevertheless, AI is capable of extracting more detailed information from image data, offering a promising avenue for enhancing the accuracy and precision of bone defect assessment. We developed a novel AI-assisted preoperative planning system to guide orthopedic surgeons' decisions about revision arthroplasty based on expert surgical case database retrieval.
We first established a novel method for acetabular bone defect reconstruction, quantifying and typing acetabular bone defects. Subsequently, we constructed a hip revision case database by collecting clinical and imaging data on 200 hip revision surgical cases from a senior national expert. The database consists of preoperative computed tomography (CT), preoperative X-Ray, postoperative X-ray, and patient demographics. We can match cases in the database based on the current bone defect characteristics of patients scheduled for surgery and find the most similar case scenarios to provide the surgeon with a preoperative reference. This approach allows the surgeon to have a preoperative idea of the acetabular revision protocol, reducing the intraoperative trial and error time.
The study received permission from the Ethics Committee of Luoyang Orthopedic-Traumatological Hospital of Henan Province. Additionally, this study was based on imaging data and would not harm the volunteers or disclose their information. Therefore, by national legislation and institutional requirements, there was no need for participants or their legal guardians/next of kin to sign an informed consent form.
1. Image import
2. Recovery of acetabular bone defect on the affected side
3. Image segmentation and reconstruction
4. Acetabular bone defect partition and defect amount calculation
5. Expert hip revision database search - acetabular defect planning
Currently, we applied this method in five cases of patients who underwent revision hip arthroplasty, including four men and one woman. The ages ranged from 42 to 67 years. They were diagnosed as aseptic prosthesis loosening after hip arthroplasty and classified based on the Paprosky classification8. The mean operative time for the five patients was 123.2 min, with a mean intraoperative blood loss of 672 mL. The operative time is the overall time, including femoral stem prosthesis revision. The det...
Due to significant anatomical damage, the intricate soft tissue condition after hip arthroplasty, and the presence of severe metal artifacts often associated with metal implants, it is frequently necessary for experienced medical professionals to utilize 3D reconstruction to comprehensively analyze imaging results and clinical manifestations in order to evaluate specific bone defects in patients and subsequently plan suitable acetabular prostheses9,10. However, e...
Author Xiaolu Xi, Ke Yuan and Qiang Xie are employed by Wuhan United Imaging Surgical Co., Ltd. The remaining authors declare that they have no competing interests.
The AI preoperative planning system in this work was supported by Wuhan United Imaging Surgical Co., Ltd.
Name | Company | Catalog Number | Comments |
PyCharm | JetBrains | 243.21565.199 | The Python IDE for data science and web development |
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