Using Artificial Intelligence to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY): Protocol for the Development of a Clinical Prediction Model

Luke Farrow*, George Patrick Ashcroft, Mingjun Zhong, Lesley Anderson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
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Abstract

Background: Hip and knee osteoarthritis is substantially prevalent worldwide, with large numbers of older adults undergoing joint replacement (arthroplasty) every year. A backlog of elective surgery due to the COVID-19 pandemic, and an aging population, has led to substantial issues with access to timely arthroplasty surgery. A potential method to improve the efficiency of arthroplasty services is by increasing the percentage of patients who are listed for surgery from primary care referrals. The use of artificial intelligence (AI) techniques, specifically machine learning, provides a potential unexplored solution to correctly and rapidly select suitable patients for arthroplasty surgery. 

Objective: This study has 2 objectives: (1) develop a cohort of patients with referrals by general practitioners regarding assessment of suitability for hip or knee replacement from National Health Service (NHS) Grampian data via the Grampian Data Safe Haven and (2) determine the demographic, clinical, and imaging characteristics that influence the selection of patients to undergo hip or knee arthroplasty, and develop a tested and validated patient-specific predictive model to guide arthroplasty referral pathways. 

Methods: The AI to Revolutionise the Patient Care Pathway in Hip and Knee Arthroplasty (ARCHERY) project will be delivered through 2 linked work packages conducted within the Grampian Data Safe Haven and Safe Haven Artificial Intelligence Platform. The data set will include a cohort of individuals aged ≥16 years with referrals for the consideration of elective primary hip or knee replacement from January 2015 to January 2022. Linked pseudo-anonymized NHS Grampian health care data will be acquired including patient demographics, medication records, laboratory data, theatre records, text from clinical letters, and radiological images and reports. Following the creation of the data set, machine learning techniques will be used to develop pattern classification and probabilistic prediction models based on radiological images. Supplemental demographic and clinical data will be used to improve the predictive capabilities of the models. The sample size is predicted to be approximately 2000 patients-a sufficient size for satisfactory assessment of the primary outcome. Cross-validation will be used for development, testing, and internal validation. Evaluation will be performed through standard techniques, such as the C statistic (area under curve) metric, calibration characteristics (Brier score), and a confusion matrix. Results: The study was funded by the Chief Scientist Office Scotland as part of a Clinical Research Fellowship that runs from August 2021 to August 2024. Approval from the North Node Privacy Advisory Committee was confirmed on October 13, 2021. Data collection started in May 2022, with the results expected to be published in the first quarter of 2024. ISRCTN registration has been completed. 

Conclusions: This project provides a first step toward delivering an automated solution for arthroplasty selection using routinely collected health care data. Following appropriate external validation and clinical testing, this project could substantially improve the proportion of referred patients that are selected to undergo surgery, with a subsequent reduction in waiting time for arthroplasty appointments.

Original languageEnglish
Article numbere37092
Number of pages7
JournalJMIR Research Protocols
Volume11
Issue number5
DOIs
Publication statusPublished - 11 May 2022

Bibliographical note

Acknowledgments
The study was funded by the Chief Scientist Office Scotland as part of a Clinical Research Fellowship that runs from August 2021 to August 2024 (CAF/21/06). LF is the grant holder and LA is the chief investigator. The authors are grateful for the input of Jenny Gregory (University of Aberdeen), Greig Nicol (NHS Grampian), Dominic Meek (Glasgow University and NHS Greater Glasgow and Clyde), and Diane Smith (patient partner) in the development of the study protocol.

Funding Information:
Results: The study was funded by the Chief Scientist Office Scotland as part of a Clinical Research Fellowship that runs from August 2021 to August 2024. Approval from the North Node Privacy Advisory Committee was confirmed on October 13, 2021. Data collection started in May 2022, with the results expected to be published in the first quarter of 2024. ISRCTN registration has been completed.

Data Availability Statement

Trial Registration:
ISRCTN Registry ISRCTN18398037; https://www.isrctn.com/ISRCTN18398037

International Registered Report Identifier (IRRID):
PRR1-10.2196/37092

Keywords

  • arthritis
  • arthroplasty
  • artificial intelligence
  • health care
  • hip
  • imaging
  • knee
  • machine learning
  • orthopedics
  • patient care
  • prediction modelling

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