Prediction of intraoperative press-fit stability of the acetabular cup in total hip arthroplasty using radiomics-based machine learning models

Background: Preoperative prediction of the acetabular cup press-fit stability in total hip arthroplasty is necessary for clinical decision-making. This study aims to establish and validate machine learning models to investigate the feasibility of predicting the intraoperative press-fit stability of the acetabular cup in total hip arthroplasty (THA). Methods: 226 patients who underwent primary THA from 2018 to 2022 in our hospital were retrospectively enrolled. Patients were divided into press-fit stable or unstable groups according to the intraoperative pull-out test of the implanted cup. Then, they were randomly assigned to the training or test cohort in an 8:2 ratio. We used 3Dslicer software to segment the region of interest (ROI) of the patient's bilateral hip X-ray to extract radiomics features. The least absolute shrinkage and selection operator (LASSO) regression was used in our feature selection. Finally, four machine learning models were employed in this study, including support vector machine (SVM), random forest (RF), logistic regression (LR), and XGBoost (XGB). Decision curve analysis (DCA), and receiver operating characteristic (ROC) curves of the models were plotted. The area under the curve (AUC), diagnostic accuracy, sensitivity, and specificity were calculated as well. The AUCs of the four models were compared using the DeLong test. Results: Twenty-seven valuable radiomics features were determined by dimensionality reduction and selection. Regarding to the DeLong test, the AUC of the XGB model was significantly different from those of the other three models. (p < 0.05). Among all models, the XGB model exhibited the best performance with an AUC of 0.823 (95 % CI: 0.711-0.919) in the test cohort and showed optimal clinical efficacy according to the DCA. Conclusion: Machine learning models based on X-ray radiomics can accurately predict the intraoperative press-fit stability of implanted cups preoperatively, providing surgeons with valuable information to lower the complication risk in THA.