Clinical Evaluation of Artificial Intelligence based Preoperative Plans for Total Knee Arthroplasty

A preoperative plan is a virtual plan that defines the implant position and orientation allowing a surgeon to prepare for surgery. However, the default preoperative plan for total knee arthroplasty proposed by the manufacturer requires changes to be made by the surgeon in more than 90% of the cases. Previous studies have shown that artificial intelligence can be used to create better preoperative plans compared to manufacturer’s default plans. However, the quality of artificial intelligence based preoperative plans has not yet been compared to surgeon approved preoperative plans. The purpose of this study is to compare default, artificial intelligence and surgeon approved preoperative plans, by having them scored on a range from 1 (totally unacceptable plan) to 5 (no corrections needed) by an experienced surgeon, while being blinded to the plan type. Through a Wilcoxon signed rank test with α=0.05, AI based preoperative plans were found to be a significant improvement upon the default plans (p-val=0.000136), while the differences in score between AI and surgeon approved preoperative plans were insignificant (p-val= 0.083). Consequently these results indicate that AI generated preoperative plans for TKA are an improvement upon current default plans, which could increase the surgeon’s planning efficiency when applied in clinical practice.