Development of an automatic surgical planning system for high tibial osteotomy using artificial intelligence

Background: This study proposed an automatic surgical planning system for high tibial osteotomy (HTO) using deep learning -based artificial intelligence and validated its accuracy. The system simulates osteotomy and measures lower -limb alignment parameters in preand post-osteotomy simulations. Methods: A total of 107 whole -leg standing radiographs were obtained from 107 patients who underwent HTO. First, the system detected anatomical landmarks on radiographs. Then, it simulated osteotomy and automatically measured five parameters in preand post-osteotomy simulation (hip knee angle [HKA], weight -bearing line ratio [WBL ratio], mechanical lateral distal femoral angle [mLDFA], mechanical medial proximal tibial angle [mMPTA], and mechanical lateral distal tibial angle [mLDTA]). The accuracy of the measured parameters was validated by comparing them with the ground truth (GT) values given by two orthopaedic surgeons. Results: All absolute errors of the system were within 1.5 degrees or 1.5%. All inter -rater correlation confidence (ICC) values between the system and GT showed good reliability (>0.80). Excellent reliability was observed in the HKA (0.99) and WBL ratios (>0.99) for the preosteotomy simulation. The intra-rater difference of the system exhibited excellent reliability with an ICC value of 1.00 for all lower -limb alignment parameters in preand postosteotomy simulations. In addition, the measurement time per radiograph (0.24 s) was considerably shorter than that of an orthopaedic surgeon (118 s). Conclusion: The proposed system is practically applicable because it can measure lowerlimb alignment parameters accurately and quickly in preand post-osteotomy simulations. The system has potential applications in surgical planning systems. (c) 2024 Elsevier B.V. All rights reserved.