HIPPO artificial intelligence: Correlating automated radiographic femoroacetabular measurements with patient-reported outcomes in developmental hip dysplasia

Background: Hip dysplasia (HD) is characterized by insufficient acetabular coverage of the femoral head, leading to a predisposition for osteoarthritis. While radiographic measurements such as the lateral center edge angle (LCEA) and Tönnis angle are essential in evaluating HD severity, patient-reported outcome measures (PROMs) offer insights into the subjective health impact on patients.

Aim: To investigate the correlations between machine-learning automated and manual radiographic measurements of HD and PROMs with the hypothesis that artificial intelligence (AI)-generated HD measurements indicating less severe dysplasia correlate with better PROMs.

Methods: Retrospective study evaluating 256 hips from 130 HD patients from a hip preservation clinic database. Manual and AI-derived radiographic measurements were collected and PROMs such as the Harris hip score (HHS), international hip outcome tool (iHOT-12), short form (SF) 12 (SF-12), and Visual Analogue Scale of the European Quality of Life Group survey were correlated using Spearman's rank-order correlation.

Results: The median patient age was 28.6 years (range 15.7-62.3 years) with 82.3% of patients being women and 17.7% being men. The median interpretation time for manual readers and AI ranged between 4-12 minutes per patient and 31 seconds, respectively. Manual measurements exhibited weak correlations with HHS, including LCEA (r = 0.18) and Tönnis angle (r = -0.24). AI-derived metrics showed similar weak correlations, with the most significant being Caput-Collum-Diaphyseal (CCD) with iHOT-12 at r = -0.25 (P = 0.042) and CCD with SF-12 at r = 0.25 (P = 0.048). Other measured correlations were not significant (P > 0.05).

Conclusion: This study suggests AI can aid in HD assessment, but weak PROM correlations highlight their continued importance in predicting subjective health and outcomes, complementing AI-derived measurements in HD management.