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Background <p>With the growing complexity of total hip arthroplasty (THA) for high hip dislocation (HHD), artificial intelligence (AI)-assisted three-dimensional (3D) preoperative planning has emerged as a promising tool to enhance surgical accuracy. This study compared clinical outcomes of AI-assisted 3D versus conventional two-dimensional (2D) X-ray preoperative planning in such cases.</p> Methods <p>A retrospective cohort of 92 patients with Crowe type II–IV HHD who underwent THA between May 2020 and January 2023 was analyzed. Patients received either AI-assisted 3D preoperative planning (<i>n</i> = 49) or 2D X-ray preoperative planning (<i>n</i> = 43). The primary outcome was the accuracy of implant size prediction. Secondary outcomes included operative time, blood loss, leg length discrepancy (LLD), implant positioning, functional scores (Harris Hip Score [HHS], WOMAC, VAS), complications, and implant survival at 24 months.</p> Results <p>At 24 months, both groups demonstrated significant improvements in functional outcomes. Compared to the 2D X-ray group, the AI-3D group showed higher accuracy in implant size prediction (acetabular cup: 59.18% vs. 30.23%; femoral stem: 65.31% vs. 41.86%; both <i>p</i> &lt; 0.05), a greater proportion of cups placed within the Lewinnek and Callanan safe zones (<i>p</i> &lt; 0.05), shorter operative time, reduced intraoperative blood loss, and more effective correction of leg length discrepancy (all <i>p</i> &lt; 0.05). No significant differences were observed in HHS, WOMAC, or VAS scores between groups at 24 months (all <i>p</i> &gt; 0.05). Implant survivorship was also comparable (100% vs. 97.7%; <i>p</i> = 0.283), with one revision noted in the 2D X-ray group.</p> Conclusion <p>AI-assisted 3D preoperative planning improves prosthesis selection accuracy, implant positioning, and perioperative outcomes in Crowe type II–IV HHD THA, although 2-year functional and survival outcomes were comparable to 2D X-ray preoperative planning. Considering the higher cost, radiation exposure, and workflow complexity, its broader application warrants further investigation, particularly in identifying patients who may benefit most.</p>

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AI-assisted 3D versus conventional 2D preoperative planning in total hip arthroplasty for Crowe type II–IV high hip dislocation: a two-year retrospective study

  • 期刊论文

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  • 发表日期：

    2025年8月20日

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  • Zhenbao Lu,
  • Cuihua Yuan,
  • Qingshan Xu,
  • Yuhua Feng,
  • Qiujin Xia,
  • Xiaolu Wang,
  • Jianfu Zhu,
  • Jinqing Wu,
  • Tihui Wang,
  • Jiliang Chen,
  • Xu Wang,
  • Qijin Wang

摘要

Background

With the growing complexity of total hip arthroplasty (THA) for high hip dislocation (HHD), artificial intelligence (AI)-assisted three-dimensional (3D) preoperative planning has emerged as a promising tool to enhance surgical accuracy. This study compared clinical outcomes of AI-assisted 3D versus conventional two-dimensional (2D) X-ray preoperative planning in such cases.

Methods

A retrospective cohort of 92 patients with Crowe type II–IV HHD who underwent THA between May 2020 and January 2023 was analyzed. Patients received either AI-assisted 3D preoperative planning (n = 49) or 2D X-ray preoperative planning (n = 43). The primary outcome was the accuracy of implant size prediction. Secondary outcomes included operative time, blood loss, leg length discrepancy (LLD), implant positioning, functional scores (Harris Hip Score [HHS], WOMAC, VAS), complications, and implant survival at 24 months.

Results

At 24 months, both groups demonstrated significant improvements in functional outcomes. Compared to the 2D X-ray group, the AI-3D group showed higher accuracy in implant size prediction (acetabular cup: 59.18% vs. 30.23%; femoral stem: 65.31% vs. 41.86%; both p < 0.05), a greater proportion of cups placed within the Lewinnek and Callanan safe zones (p < 0.05), shorter operative time, reduced intraoperative blood loss, and more effective correction of leg length discrepancy (all p < 0.05). No significant differences were observed in HHS, WOMAC, or VAS scores between groups at 24 months (all p > 0.05). Implant survivorship was also comparable (100% vs. 97.7%; p = 0.283), with one revision noted in the 2D X-ray group.

Conclusion

AI-assisted 3D preoperative planning improves prosthesis selection accuracy, implant positioning, and perioperative outcomes in Crowe type II–IV HHD THA, although 2-year functional and survival outcomes were comparable to 2D X-ray preoperative planning. Considering the higher cost, radiation exposure, and workflow complexity, its broader application warrants further investigation, particularly in identifying patients who may benefit most.