Evaluation of artificial intelligence models for osteoarthritis of the knee using deep learning algorithms for orthopedic radiographs


Deep learning, a form of artificial intelligence, has shown promising results for interpreting radiographs. In order to develop this niche machine learning (ML) program of interpreting orthopedic radiographs with accuracy, a project named deep learning algorithm for orthopedic radiographs was conceived. In the first phase, the diagnosis of knee osteoarthritis (KOA) as per the standard Kellgren-Lawrence (KL) scale in medical images was conducted using the deep learning algorithm for orthopedic radiographs.


To compare efficacy and accuracy of eight different transfer learning deep learning models for detecting the grade of KOA from a radiograph and identify the most appropriate ML-based model for the detecting grade of KOA.


The study was performed on 2068 radiograph exams conducted at the Department of Orthopedic Surgery, Sir HN Reliance Hospital and Research Centre (Mumbai, India) during 2019-2021. Three orthopedic surgeons reviewed these independently, graded them for the severity of KOA as per the KL scale and settled disagreement through a consensus session. Eight models, namely ResNet50, VGG-16, InceptionV3, MobilnetV2, EfficientnetB7, DenseNet201, Xception and NasNetMobile, were used to evaluate the efficacy of ML in accurately classifying radiographs for KOA as per the KL scale. Out of the 2068 images, 70% were used initially to train the model, 10% were used subsequently to test the model, and 20% were used finally to determine the accuracy of and validate each model. The idea behind transfer learning for KOA grade image classification is that if the existing models are already trained on a large and general dataset, these models will effectively serve as generic models to fulfill the study’s objectives. Finally, in order to benchmark the efficacy, the results of the models were also compared to a first-year orthopedic trainee who independently classified these models according to the KL scale.


Our network yielded an overall high accuracy for detecting KOA, ranging from 54% to 93%. The most successful of these was the DenseNet model, with accuracy up to 93%; interestingly, it even outperformed the human first-year trainee who had an accuracy of 74%.


The study paves the way for extrapolating the learning using ML to develop an automated KOA classification tool and enable healthcare professionals with better decision-making.


Artificial intelligence; Computer vision; Deep learning; Knee; Machine leaning; Osteoarthritis.

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