Abstract
Although artificial intelligence models have demonstrated high accuracy in identifying specific orthopedic implant models from imaging, which is an important and time-consuming task, the scope of prior works and performance of prior models have not been evaluated. We performed a systematic review to summarize the scope, methodology, and performance of artificial intelligence algorithms in classifying orthopedic implant models. We performed a literature search in PubMed, EMBASE, and the Cochrane Library for studies published up to March 10, 2021, using search terms related to “artificial intelligence”, “orthopedic”, “implant”, and “arthroplasty”. Studies were assessed using a modified version of the methodologic index for non-randomized studies. Reported outcomes included area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. The search identified 2689 records, of which 11 were included in the final review. The number of implant models evaluated ranged from 2 to 27. Five studies reported overall AUC across all included models which ranged from 0.94 to 1.0. Overall accuracy values ranged from 0.804 to 1.0. One study compared AI model performance with that of three surgeons, reporting similar performance. There was a large degree of variation in methodology and reporting quality. Artificial intelligence algorithms have demonstrated strong performance in classifying orthopedic implant models from radiographs. Further research is needed to compare artificial intelligence alone and as an adjunct with human experts in implant identification. Future studies should aim to adhere to rigorous artificial intelligence development methods and thorough, transparent reporting of methods and results.
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Schwartz AM, Farley KX, Guild GN, Bradbury TL Jr. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplast. 2020;35(6 Suppl):S79.
Branovacki G. Hip arthroplasty U.S. femoral implants 1938–2008. Chicago: Ortho Atlas Publishing Inc.; 2008.
Wilson NA, Jehn M, York S, Davis CM. Revision total hip and knee arthroplasty implant identification: implications for use of unique device identification 2012 AAHKS member survey results. J Arthroplast. 2014;29(2):251–5.
Wilson N, Broatch J, Jehn M, Davis C. National projections of time, cost and failure in implantable device identification: consideration of unique device identification use. Healthcare (Amsterdam, Netherlands). 2015;3(4):196–201.
Giger ML. Machine learning in medical imaging. J Am Coll Radiol. 2018;15(3):512–20.
Liu F, Kijowski R. Deep learning in musculoskeletal imaging. Adv Clin Radiol. 2019;1:83–94.
Borjali A, Chen AF, Muratoglu OK, Morid MA, Varadarajan KM. Detecting total hip replacement prosthesis design on plain radiographs using deep convolutional neural network. J Orthop Res. 2020;38(7):jor.24617.
Yi PHPH, Wei J, Kim TKTK, Sair HIHI, Hui FKFK, Hager GDGD, et al. Automated detection & classification of knee arthroplasty using deep learning. Knee. 2020;27(2):535–42.
Urban G, Porhemmat S, Stark M, Feeley B, Okada K, Baldi P. Classifying shoulder implants in X-ray images using deep learning. Comput Struct Biotechnol J. 2020;18:967–72.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, The PRISMA, et al. statement: an updated guideline for reporting systematic reviews. BMJ. 2020;2021:372.
Langerhuizen DWG, Janssen SJ, Mallee WH, Van Den Bekerom MPJ, Ring D, Kerkhoffs GMMJ, et al. What are the applications and limitations of artificial intelligence for fracture detection and classification in orthopaedic trauma imaging? A systematic review. Clin Orthop Relat Res. 2019;477(11):2482–91.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6.
Borjali A, Chen AF, Bedair HS, Melnic CM, Muratoglu OK, Morid MA, et al. Comparing the performance of a deep convolutional neural network with orthopedic surgeons on the identification of total hip prosthesis design from plain radiographs. Med Phys. 2021;3:196.
Huang KT, Silva MA, See AP, Wu KC, Gallerani T, Zaidi HA, et al. A computer vision approach to identifying the manufacturer and model of anterior cervical spinal hardware. J Neurosurg Spine. 2019;6:1–7.
Kang Y, Yoo J, Cha Y, Park CH. Kim J (2020) Machine learning–based identification of hip arthroplasty designs. J Orthop Transl. 2020;21:13–7.
Karnuta JM, Haeberle HS, Luu BC, Roth AL, Molloy RM, Nystrom LM, et al. Artificial intelligence to identify arthroplasty implants from radiographs of the hip. J Arthroplast. 2020. https://doi.org/10.1016/j.arth.2020.11.015.
Karnuta JM, Luu BC, Roth AL, Haeberle HS, Chen AF, Iorio R, et al. Artificial intelligence to identify arthroplasty implants from radiographs of the knee. J Arthroplast. 2020;36(3):935–40.
Murphy M, Killen C, Burnham R, Sarvari F, Wu K, Brown N. Artificial intelligence accurately identifies total hip arthroplasty implants: a tool for revision surgery. HIP Int. 2021. https://doi.org/10.1177/1120700020987526.
Yang H-S, Kim K-R, Kim S, Park J-Y. Deep learning application in spinal implant identification. Spine (Phila Pa 1976). 2021;46(5):E318-24.
Yi PH, Kim TK, Wei J, Li X, Hager GD, Sair HI, et al. Automated detection and classification of shoulder arthroplasty models using deep learning. Skelet Radiol. 2020;49(10):1623–32.
Aggarwal R, Sounderajah V, Martin G, Ting DSW, Karthikesalingam A, King D, et al. Diagnostic accuracy of deep learning in medical imaging: a systematic review and meta-analysis. npj Digit Med. 2021. https://doi.org/10.1038/s41746-021-00438-z.
Ren M, Yi PH. Deep learning detection of subtle fractures using staged algorithms to mimic radiologist search pattern. Skelet Radiol. 2021. https://doi.org/10.1007/s00256-021-03739-2.
Park SH, Han K. Methodologic guide for evaluating clinical performance and effect of artificial intelligence technology for medical diagnosis and prediction. Radiology. 2018;286(3):800–9. https://doi.org/10.1148/radiol2017171920.
Zech JR, Badgeley MA, Liu M, Costa AB, Titano JJ, Oermann EK. Variable generalization performance of a deep learning model to detect pneumonia in chest radiographs: a cross-sectional study. PLOS Med. 2018;15(11):e1002683.
Kim DW, Jang HY, Kim KW, Shin Y, Park SH. Design Characteristics of studies reporting the performance of artificial intelligence algorithms for diagnostic analysis of medical images: results from recently published papers. Korean J Radiol. 2019;20(3):405. https://doi.org/10.3348/kjr.2019.0025.
Yusuf M, Atal I, Li J, Smith P, Ravaud P, Fergie M, et al. Reporting quality of studies using machine learning models for medical diagnosis: a systematic review. BMJ Open. 2020;10(3):e034568.
Collins GS, Moons KGM. Reporting of artificial intelligence prediction models. Lancet. 2019;393(10181):1577–9.
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Ren, M., Yi, P.H. Artificial intelligence in orthopedic implant model classification: a systematic review. Skeletal Radiol 51, 407–416 (2022). https://doi.org/10.1007/s00256-021-03884-8
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DOI: https://doi.org/10.1007/s00256-021-03884-8