Digital Fluoroscopic Navigation for Limb Length Restoration During Anterior Total Hip Arthroplasty

Does Artificial Intelligence Outperform Humans Using Fluoroscopic-Assisted Computer Navigation for Total Hip Arthroplasty?

“…have evaluated the use of DA THA with standard fluoroscopy to guide component placement and reported more accurate postoperative LLD (1.6 mm) compared to non-navigated posterior THA (5.5 mm) ( P < .0001) [ 28 ]. Using fluoroscopic-assisted computer navigation software, O’Leary and colleagues report LLD accuracy within ± 3 mm of the intended target in 66% of THAs, which was a statistical improvement over the LLD accuracy (40% within ± 3 mm of the intended target) using standard fluoroscopy ( P < .01) [ 15 ]. Our data are consistent with the previous authors in that we report a high degree of LLD accuracy using fluoroscopic-assisted AI computer navigation; on final radiographs, 66% of THAs were within 2 mm of the AI-navigated intraoperative LLD, and 98% were within 5 mm.…”

“…Previous authors have compared the use of fluoroscopic-assisted computer navigation to standard fluoroscopy for assessing LLD, where the primary outcome of interest was the difference between the mean planned and actual LLD. Categorizing this difference into 6 categories (up to 1 mm, 1-2 mm, 2-3 mm, 3-4 mm, 4-5 mm, and >5 mm), the authors performed a sample size calculation and determined that a minimum sample of 100 patients (50 per group) was required to achieve a power of 0.8 [ 15 ]. We further performed a sample size/power calculation (assuming α = 0.05 and power = 0.8) and determined the total sample size required to be 376 subjects (188 in each group) to determine a clinically significant 5% difference between manual and AI groups for ΔLLD within ±5 mm.…”

“…Fluoroscopic imaging is relatively easy to perform in the supine position and allows intraoperative qualitative assessment of cup position and leg length by the surgeon. Recently, computer navigation software has been introduced that allows quantitative assessment of acetabular cup position and leg lengths on fluoroscopic images [ 14 , 15 ]. Early versions of this software allow intraoperative calculation of cup inclination, cup anteversion, and LLD but require inputs from a human technician to register anatomic landmarks.…”