Comprehensive Summary
This study compares the operative outcomes of AI-assisted 3D preoperative planning versus traditional 2D X-ray planning for total hip arthroplasty (THA) in patients with high hip dislocation (HHD). A total of 92 patients with Crowe type II–IV HHD were randomly assigned to undergo either AI-assisted 3D or traditional 2D preoperative planning prior to a THA. These patients were then assessed on the accuracy of the implant size prediction, operative time, blood loss, leg length discrepancy (LLD), implant positioning, functional scores (Harris Hip Score [HHS], WOMAC, VAS), complications, and implant survival (at 24 months). Compared with the 2D group, the AI-assisted 3D planning group demonstrated higher accuracy in implant size prediction (59.2% vs. 30.2% for acetabular cups; 65.3% vs. 41.9% for femoral stems), a greater proportion of cups positioned within Lewinnek and Callanan safe zones, reduced operative time and intraoperative blood loss, and more precise correction of leg length discrepancies. It is important to note that while there was a significant improvement in short-term functions, there was no significant difference in long-term clinical value (24 months).
Outcomes and Implications
Specific surgical conditions, such as the presence of acetabular dysplasia, proximal femoral deformities, and inadequate bone stock, make accurate anatomical positioning of the acetabular cup extremely challenging during THA. Moreover, with a dislocation rate of 7.2% for patients with Crowe type IV DDH, current 2D preoperative planning techniques are in urgent need of improvement. The results confirm that 3D planning enables more effective THA procedures and leads to improved short-term patient outcomes. However, because 3D planning involves higher costs, increased radiation exposure, and greater workflow complexity, the authors recommend follow-up studies to identify which patient groups are likely to benefit most from this technology. They also call for further research to establish the long-term advantages of 3D planning over 2D methods before its widespread clinical adoption.