Developing a Computer Vision Model to Automate Quantitative Measurement of Hip-Knee-Ankle Angle in Total Hip and Knee Arthroplasty Patients

Abstract

Background: Increasing deformity of the lower extremities, as measured by the Hip-Knee-Ankle Angle (HKAA), is associated with poor patient outcomes after total hip and knee arthroplasty (THA, TKA). Automated calculation of HKAA is imperative to reduce the burden on orthopaedic surgeons. We proposed a detection-based deep learning (DL) model to calculate HKAA in THA and TKA patients and assessed the agreement between DL-derived HKAAs and manual measurement.

Methods: We retrospectively identified 1,379 long-leg radiographs (LLR) from patients scheduled for THA or TKA within an academic medical center. There were 1,221 LLRs used to develop the model (randomly split into 70% training, 20% validation, and 10% held-out test sets); 158 LLRs were considered "difficult," as the femoral head was difficult to distinguish from surrounding tissue. There were two raters who annotated the HKAA of both lower extremities, and inter-rater reliability was calculated to compare the DL-derived HKAAs with manual measurement within the test set.

Results: The DL model achieved a mean average precision of 0.985 on the test set. The average HKAA of the operative leg was 173.05 +/- 4.54°; the non-operative leg was 175.55 +/- 3.56°. The inter-rater reliability between manual and DL-derived HKAA measurements on the operative leg and non-operative leg indicated excellent reliability (Intraclass Correlation (ICC) (2,k) = 0.987 [0.96, 0.99], ICC (2,k) = 0.987 [0.98, 0.99, respectively]). The standard error of measurement for the DL-derived HKAA for the operative and non-operative legs was 0.515° and 0.403°, respectively.

Conclusion: A detection-based DL algorithm can calculate the HKAA in LLRs and is comparable to that calculated by manual measurement. The algorithm can detect the bilateral femoral head, knee, and ankle joints with high precision, even in patients where the femoral head is difficult to visualize.

Keywords: Computer Vision; Deep Learning; Hip-Knee-Ankle Angle; Lower Extremity Alignment; Total Hip Arthroplasty; Total Knee Arthroplasty.