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Hip arthroplasty dislocation risk calculator: evaluation of one million primary implants and twenty-five thousand dislocations with deep learning artificial intelligence in a systematic review of reviews

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Abstract

Purpose

This paper aims to provide an overview of the possibility regarding the artificial intelligence application in orthopaedics to predict dislocation with a calculator according to the type of implant (hemiarthroplasty, standard total hip arthroplasty, dual mobility, constrained cups) after primary arthroplasty.

Material and methods

Among 75 results for primary arthroplasties, 26 articles were reviews on dislocation after hemiarthroplasty, 40 after standard total hip arthroplasty, seven about primary dual-mobility arthroplasty (DM THA), and two reviews about constrained implants. Although our search method for systematic reviews covers ten years (2012–2022), none for dual mobility was published before 2016, showing a recent explosion of original articles on this subject. A total of 1,069,565 implants and 26,488 dislocations in primary arthroplasties are included in these 75 reviews. We used a supervised learning model in which models assign objects to groups as input and artificial neural network (ANN) with nodes, hidden layers, and output layers. We considered only four implant types as the input layer. We considered the patient’s factors (indication for THA, demographics, spine surgery, and neurologic disease) as the second input values (hidden layer). We considered the implant position as the third input (hidden layer) property including head size, combined anteversion, or spinopelvic alignment. Surgery-related factors, approach, capsule repair, etc. were the fourth input values (hidden layer). The output was a post-operative dislocation or not within three months.

Results

The accuracy for predicting dislocation with this systematic review was 95%. Dislocation risk, based on the type of implant, was wide-ranging, from 0 to 3.9% (mean 0.31%) for the 3045 DM THA, from 0.2 to 1.2% (overall 0.91%) for the 457 constrained liners, from 1.76 to 4.2% (mean 2.1%) for 895,734 conventional total hip arthroplasties, and from 0.76 to 12.2% (mean 4.5%) for 170,329 hemiarthroplasties. In the conventional THA group, many factors increase the risk of dislocation according to the calculator, and only a few (big head, anterior approach) decrease the risk, but not very significantly. In the hemiarthroplasty group, many factors can increase the risk of dislocation until 30%, but none could decrease the risk. According to the calculator, the DM THA and the constrained liner markedly decreased the risk and were not affected by implant position, spine surgery, and spinopelvic position.

Conclusion

To our knowledge, this study is the first to yield an implant-specific dislocation risk calculator that incorporates the patient’s comorbidities, the position of components, and surgery factors affecting instability risk.

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Data availability

Available on reasonable request from PubMed.

Code availability

None.

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Acknowledgements

The authors thank the Paris-Saclay University for reviewing mathematics data.

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Authors and Affiliations

  1. University Paris East, Paris, France

    Philippe Hernigou

  2. Hopital Sainte-Anne, Toulon, France

    Olivier Barbier

  3. Laboratoire Bauerfeind, Tremblay, France

    Philippe Chenaie

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  1. Philippe Hernigou
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  2. Olivier Barbier
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  3. Philippe Chenaie
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Contributions

Data collection (PH, OB) and redaction (PH, PC).

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Correspondence to Philippe Hernigou.

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Hernigou, P., Barbier, O. & Chenaie, P. Hip arthroplasty dislocation risk calculator: evaluation of one million primary implants and twenty-five thousand dislocations with deep learning artificial intelligence in a systematic review of reviews. International Orthopaedics (SICOT) 47, 557–571 (2023). https://doi.org/10.1007/s00264-022-05644-2

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