Artificially Intelligent Three-Dimensionally-Printed Patient-Specific Instrument Improves Total Hip Arthroplasty Accuracy

Background: Patient-specific instrumentation (PSI) has the potential to improve the accuracy of implant positioning in total hip arthroplasty (THA). This prospective clinical study aimed to develop artificial in-telligence to increase PSI production efficiency and assess accuracy, clinical outcomes, and learning curves.Methods: A convolutional neural network was applied to automatically process computer tomography im-ages. PSI size and position were designed to guide the acetabular preparation and femoral neck resection. Thirty patients who underwent PSI-assisted THAs were matched to thirty patients who underwent free-hand THAs, and the component positions, as well as radiographic and clinical outcomes were analyzed.Results: PSI-assisted THA was significantly more accurate than free-hand THA at achieving the target component position. The mean absolute errors of cup inclination (P =.004) and anteversion (P < .001) were significantly smaller in the PSI group with fewer outliers. Calcar length (P =.002) and neck length (P =.026) were also more accurate in the PSI group. The leg length discrepancy was significantly lower in the PSI group (P = .002). There were no significant differences in operation time, blood loss, leg length discrepancy, or cup position among the first, second, and last 10 cases.Conclusion: PSI-assisted THA offered more accurate component positions and better radiographic out-comes than free-hand THA. There was no evidence of a learning curve. Our findings suggest that PSI is a convenient and practical option to help surgeons achieve accurate surgical outcomes.(c) 2022 Elsevier Inc. All rights reserved.