Artificial intelligence assisted total hip arthroplasty for patients with Crowe type <b>Ⅳ</b> developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIA Tianwei ¹ , LIU Xingyu ^2,3 , LIU Jinzhu ¹ , ZHANG Changhao ¹ , ZHANG Zhiguang ¹ , FAN Yanxing ¹ , ZHANG Chao ¹ ,  ZHANG Yiling ³ ,  SHEN Jirong ¹

1. Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China;
2. School of Life Sciences, Tsinghua University, Beijing, 100089, P.R.China;
3. Longwood Valley Medical Technology Co. Ltd., Beijing, 100176, P.R.China;

Corresponding?author：

ZHANG Yiling, Email: ylzhang@changmugu.com; SHEN Jirong, Email: joint66118@sina.com

Keywords：

Artificial intelligence; total hip arthroplasty; subtrochanteric shortening osteotomy; developmental dysplasia of the hip; preoperative planning

DOI：

10.7507/1002-1892.202106103

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Objective To investigate the early effectiveness of artificial intelligence (AI) assisted total hip arthroplasty (THA) system (AIHIP) in the treatment of patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH).Methods The clinical data of 23 patients with Crowe type Ⅳ DDH who met the selection criteria between May 2019 and December 2020 were retrospectively analyzed. There were 3 males and 20 females, the age ranged from 44 to 74 years, with an average of 52.65 years. The absolute value of the lower limbs discrepancy before operation was (15.17±22.17) mm. The preoperative Harris score was 62.4±7.2. The AIHIP system was used for preoperative planning, and the operations were all performed via conventional posterolateral approach. Thirteen patients with difficulty in reduction during operation underwent subtrochanteric shortening osteotomy (SSOT). The operation time, hospital stay, and adverse events were recorded; Harris score was used to evaluate the function of the affected limb at 1 day before operation and 1 week and 6 months after operation; pelvic anteroposterior X-ray film was taken at 1 day after operation to evaluate the position of the prosthesis. The matching degree of prosthesis was evaluated according to the consistency of intraoperative prosthesis model and preoperative planning.Results The matching degree of acetabular cup model after operation was 16 cases of perfect matching, 4 cases of general matching (1 case of +1, 3 cases of –1), and 3 cases of mismatch (all of them were +2), the coincidence rate was 86.96%. The matching degree of femoral stem model was perfect matching in 22 cases and general matching in 1 case of –1, and the coincidence rate was 100%. One patient had a periprosthesis fracture during operation, and was fixed with a wire cable during operation, and walked with the assistance of walking aid at 6 weeks after operation; the rest of the patients walked with the assistance of walking aid at 1 day after operation. The operation time was 185-315 minutes, with an average of 239.43 minutes; the hospital stay was 8-20 days, with an average of 9.96 days; and the time of disengagement from the walking aid was 2-56 days, with an average of 5.09 days. All patients were followed up 6 months. All incisions healed by first intension, and there was no complication such as infection, dislocation, refracture, and lower extremity deep venous thrombosis; X-ray films at 1 day and 6 months after operation showed that the acetabular and femoral prostheses were firmly fixed and within the safe zone; the absolute value of lower limbs discrepancy at 1 day after operation was (11.96±13.48) mm, which was not significantly decreased compared with that before operation (t=0.582, P=0.564). All osteotomies healed at 6 months after operation. The Harris scores at 1 week and 6 months after operation were 69.5±4.9 and 79.2±5.7 respectively, showing significant differences between pre- and post-operation (P<0.05). At 6 months after operation, the hip function was evaluated according to Harris score, and 13 cases were good, 9 cases were fair, and 1 case was poor.Conclusion AIHIP system-assisted THA (difficult to reposition patients combined with SSOT) for adult Crowe type Ⅳ DDH has high preoperative planning accuracy, easy intraoperative reduction, early postoperative landing, and satisfactory short-term effectiveness.

Citation： XIA Tianwei, LIU Xingyu, LIU Jinzhu, ZHANG Changhao, ZHANG Zhiguang, FAN Yanxing, ZHANG Chao, ZHANG Yiling, SHEN Jirong. Artificial intelligence assisted total hip arthroplasty for patients with Crowe type Ⅳ developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(10): 1265-1272. doi: 10.7507/1002-1892.202106103 Copy

1.	張立軍, 吉士俊, 李連永. 發育性髖關節發育不良的診治策略. 臨床小兒外科雜志, 2012, 11(3): 161-165.
2.	黃繼文. 發育性髖關節發育不良治療的研究進展. 現代醫藥衛生, 2017, 33(5): 712-714.
3.	林權德, 邱永榮, 邱漢民, 等. 全髖置換治療成人髖關節發育不良繼發骨性關節炎. 中國醫藥指南, 2016, 14(3): 80-81.
4.	Du YQ, Sun JY, Ma HY, et al. Leg length balance in total hip arthroplasty for patients with unilateral Crowe type Ⅳ developmental dysplasia of the hip. Orthop Surg, 2020, 12(3): 749-755.
5.	Du YQ, Zhang B, Sun JY, et al. The variation of the pelvis in unilateral Crowe type Ⅳ developmental dysplasia of the hip. Orthop Surg, 2021, 13(2): 546-552.
6.	Hawker GA. Who, when, and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol, 2006, 18(5): 526-530.
7.	Li Y, Zhang X, Wang Q, et al. Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-Ⅳ developmental dysplasia of the hip: classification and management. Bone Joint J, 2017, 99-B(7): 872-879.
8.	Liu T, Wang S, Huang G, et al. Treatment of Crowe Ⅳ developmental dysplasia of the hip with cementless total hip arthroplasty and shortening subtrochanteric osteotomy. J Int Med Res, 2019, 47(7): 3223-3233.
9.	Ma HY, Lu Q, Sun JY, et al. One-stage total hip arthroplasty with modular S-ROM stem for patients with bilateral Crowe type Ⅳ developmental dysplasia. Orthop Surg, 2020, 12(6): 1913-1922.
10.	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.
11.	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.
12.	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.
13.	張先龍, 王坤正. 關節外科的未來——數字骨科技術在關節外科的應用. 中華骨科雜志, 2021, 41(8): 525-531.
14.	Mahmood SS, Mukka SS, Crnalic S, et al. The influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study. J Arthroplasty, 2015, 30(9): 1638-1642.
15.	吳東, 柴偉, 劉星宇, 等. 人工智能全髖關節置換術髖臼杯放置算法的實驗研究. 中華骨科雜志, 2021, 41(3): 176-185.
16.	Nakata K, Nishikawa M, Yamamoto K, et al. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty, 2009, 24(5): 698-704.
17.	Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. J Bone Joint Surg (Br), 1999, 81(3): 431-435.
18.	霍佳邦, 趙暢, 黃廣鑫, 等. CT數據三維規劃預測全髖關節置換假體型號及截骨的準確性與可復性. 中國組織工程研究, 2021, 25(27): 4294-4299.
19.	徐征宇, 杜俊煒, 姜瑤, 等. 三維數字規劃和二維膠片模板測量輔助全髖關節置換的效果比較. 生物骨科材料與臨床研究, 2021, 18(2): 17-22.
20.	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.
21.	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.
22.	Wang D, Li DH, Li Q, et al. Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip. BMC Musculoskelet Disord, 2017, 18(1): 491. doi: 10.1186/s12891-017-1857-x.
23.	唐佩福, 王巖, 盧世璧. 坎貝爾骨科手術學. 北京: 北京大學醫學出版社, 2018: 217.

1. 張立軍, 吉士俊, 李連永. 發育性髖關節發育不良的診治策略. 臨床小兒外科雜志, 2012, 11(3): 161-165.
2. 黃繼文. 發育性髖關節發育不良治療的研究進展. 現代醫藥衛生, 2017, 33(5): 712-714.
3. 林權德, 邱永榮, 邱漢民, 等. 全髖置換治療成人髖關節發育不良繼發骨性關節炎. 中國醫藥指南, 2016, 14(3): 80-81.
4. Du YQ, Sun JY, Ma HY, et al. Leg length balance in total hip arthroplasty for patients with unilateral Crowe type Ⅳ developmental dysplasia of the hip. Orthop Surg, 2020, 12(3): 749-755.
5. Du YQ, Zhang B, Sun JY, et al. The variation of the pelvis in unilateral Crowe type Ⅳ developmental dysplasia of the hip. Orthop Surg, 2021, 13(2): 546-552.
6. Hawker GA. Who, when, and why total joint replacement surgery? The patient’s perspective. Curr Opin Rheumatol, 2006, 18(5): 526-530.
7. Li Y, Zhang X, Wang Q, et al. Equalisation of leg lengths in total hip arthroplasty for patients with Crowe type-Ⅳ developmental dysplasia of the hip: classification and management. Bone Joint J, 2017, 99-B(7): 872-879.
8. Liu T, Wang S, Huang G, et al. Treatment of Crowe Ⅳ developmental dysplasia of the hip with cementless total hip arthroplasty and shortening subtrochanteric osteotomy. J Int Med Res, 2019, 47(7): 3223-3233.
9. Ma HY, Lu Q, Sun JY, et al. One-stage total hip arthroplasty with modular S-ROM stem for patients with bilateral Crowe type Ⅳ developmental dysplasia. Orthop Surg, 2020, 12(6): 1913-1922.
10. 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.
11. 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.
12. 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.
13. 張先龍, 王坤正. 關節外科的未來——數字骨科技術在關節外科的應用. 中華骨科雜志, 2021, 41(8): 525-531.
14. Mahmood SS, Mukka SS, Crnalic S, et al. The influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study. J Arthroplasty, 2015, 30(9): 1638-1642.
15. 吳東, 柴偉, 劉星宇, 等. 人工智能全髖關節置換術髖臼杯放置算法的實驗研究. 中華骨科雜志, 2021, 41(3): 176-185.
16. Nakata K, Nishikawa M, Yamamoto K, et al. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty, 2009, 24(5): 698-704.
17. Pradhan R. Planar anteversion of the acetabular cup as determined from plain anteroposterior radiographs. J Bone Joint Surg (Br), 1999, 81(3): 431-435.
18. 霍佳邦, 趙暢, 黃廣鑫, 等. CT數據三維規劃預測全髖關節置換假體型號及截骨的準確性與可復性. 中國組織工程研究, 2021, 25(27): 4294-4299.
19. 徐征宇, 杜俊煒, 姜瑤, 等. 三維數字規劃和二維膠片模板測量輔助全髖關節置換的效果比較. 生物骨科材料與臨床研究, 2021, 18(2): 17-22.
20. 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.
21. 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.
22. Wang D, Li DH, Li Q, et al. Subtrochanteric shortening osteotomy during cementless total hip arthroplasty in young patients with severe developmental dysplasia of the hip. BMC Musculoskelet Disord, 2017, 18(1): 491. doi: 10.1186/s12891-017-1857-x.
23. 唐佩福, 王巖, 盧世璧. 坎貝爾骨科手術學. 北京: 北京大學醫學出版社, 2018: 217.

Chinese Journal of Reparative and Reconstructive Surgery

Artificial intelligence assisted total hip arthroplasty for patients with Crowe type Ⅳ developmental dysplasia of the hip

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