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Previous studies have shown that the manufacturer’s default preoperative plans for total knee arthroplasty with patient-specific guides require frequent, time-consuming changes by the surgeon. Currently, no research has been done on predicting preoperative plans for orthopedic surgery using machine learning. Therefore, this study aims to evaluate whether artificial intelligence (AI) driven planning tools can create surgeon and patient-specific preoperative plans that require fewer changes by the surgeon. A dataset of 5409 preoperative plans, including the manufacturer’s default and the plans corrected by 39 surgeons, was collected. Features were extracted from the preoperative plans that describe the implant sizes, position, and orientation in a surgeon- and patient-specific manner. Based on these features, non-linear regression models were employed to predict the surgeon’s corrected preoperative plan. The average number of corrections a surgeon has to make to the preoperative plan generated using AI was reduced by 39.7% compared to the manufacturer’s default plan. The femoral and tibial implant size in the manufacturer’s plan was correct in 68.4% and 73.1% of the cases, respectively, while the AI-based plan was correct in 82.2% and 85.0% of the cases, respectively, compared to the surgeon approved plan. Our method successfully demonstrated the use of machine learning to create preoperative plans in a surgeon- and patient-specific manner for total knee arthroplasty.

Preoperative determination of implant size for total knee arthroplasty surgery has numerous clinical and logistical benefits. Currently, surgeons use X-ray-based templating to estimate implant size, but this method has low accuracy. Our study aims to improve accuracy by developing a machine learning approach that predicts the required implant size based on a 3D femoral bone mesh, the key factor in determining the correct implant size. A linear regression framework imposing group sparsity on the 3D bone mesh vertex coordinates was proposed based on a dataset of 446 MRI scans. The group sparse regression method was further regularized based on the connectivity of the bone mesh to enforce neighbouring vertices to have similar importance to the model. Our hypergraph regularized group lasso had an accuracy of 70.1% in predicting femoral implant size while the initial implant size prediction provided by the instrumentation manufacturer to the surgeon has an accuracy of 23.1%. Furthermore, our method was capable of predicting the implant size up to one size smaller or larger with an accuracy of 99.1%, thereby surpassing other state-of-the-art methods. The hypergraph regularized group lasso was able to obtain a significantly higher accuracy compared to the implant size prediction provided by the instrumentation manufacturer.