Measurement of the Acetabular Cup Orientation after Total Hip Arthroplasty Based on Three-Dimensional Reconstruction from a Single X-ray Image Using Generative Adversarial Networks.

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Abstract

The purpose of this study was to reconstruct three-dimensional (3D) computed tomography (CT) images from single anteroposterior (AP) postoperative total hip arthroplasty (THA) X-ray images using a deep learning algorithm known as generative adversarial networks (GANs) and to validate the accuracy of cup angle measurement on GAN-generated CT.We used two GAN-based models, CycleGAN and X2CT-GAN, to generate 3D CT images from X-ray images of 386 patients who underwent primary THAs using a cementless cup. The training dataset consisted of 522 CT images and 2,282 X-ray images. The image quality was validated using the peak signal-to-noise ratio (PSNR) and the structural similarity index measure (SSIM). The cup anteversion and inclination measurements on the GAN-generated CT images were compared with the actual CT measurements. Statistical analyses of absolute measurement errors were performed using Mann-Whitney U tests and nonlinear regression analyses.The study successfully achieved 3D reconstruction from single AP postoperative THA X-ray images using GANs, exhibiting excellent PSNR (37.40) and SSIM (0.74). The median absolute difference in radiographic anteversion (RA) was 3.45° and the median absolute difference in radiographic inclination (RI) was 3.25°, respectively. Absolute measurement errors tended to be larger in cases with cup malposition than in those with optimal cup orientation.This study demonstrates the potential of GANs for 3D reconstruction from single AP postoperative THA X-ray images to evaluate cup orientation. Further investigation and refinement of this model are required to improve its performance.Copyright © 2024. Published by Elsevier Inc.