Application and evaluation of artificial intelligence 3D preoperative planning software in developmental dysplasia of the hip

Background: Accurate preoperative planning is crucial for successful total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The aim of this study was to compare the accuracy of an artificial intelligence-assisted three-dimensional (3D) planning system (AIHIP) with two-dimensional templates in predicting acetabular cup size in THA for DDH. Method: This study retrospectively analyzed image data from 103 DDH patients who had THA between May 2019 and August 2023. AIHIP was used for 3D planning and two-dimensional (2D) templates were used by two experienced surgeons. Accuracy was assessed by comparing predicted and actual cup sizes, and potential factors affecting accuracy were analyzed, including gender, side, BMI, and dysplasia classification. Results: : AIHIP had higher accuracy in predicting the acetabular cup size compared to the 2D template. Within ±0 size, AIHIP's accuracy was 84.1%, while the 2D template's was 64.0% (P <0.05). Within ±1 size, AIHIP's accuracy was 95.1%, while the 2D template's was 81.1% (P <0.05). Accuracy was unaffected by gender, side, or BMI but was by DDH classification. In subgroup analysis, AIHIP's mean absolute error (0.21±0.54) was significantly lower than the 2D template's (0.62±0.95) for Crowe II and Crowe III (P <0.05). Conclusion: AIHIP is superior to 2D templates in predicting the acetabular cup size accurately for THA in DDH patients. AIHIP may be especially beneficial for Crowe II and III DDH patients, as 2D templates may not accurately predict cup size in these cases.