Artificial Intelligence Radiographic Analysis Tool for Total Knee Arthroplasty

J Arthroplasty. 2023 Jul;38(7 Suppl 2):S199-S207.e2. doi: 10.1016/j.arth.2023.02.053. Epub 2023 Feb 27.


Background: The postoperative follow-up of a patient after total knee arthroplasty (TKA) requires regular evaluation of the condition of the knee through interpretation of X-rays. This rigorous analysis requires expertize, time, and methodical standardization. Our work evaluated the use of an artificial intelligence tool, X-TKA, to assist surgeons in their interpretation.

Methods: A series of 12 convolutional neural networks were trained on a large database containing 39,751 X-ray images. These algorithms are able to determine examination quality, identify image characteristics, assess prosthesis sizing and positioning, measure knee-prosthesis alignment angles, and detect anomalies in the bone-cement-implant complex. The individual interpretations of a pool of senior surgeons with and without the assistance of X-TKA were evaluated on a reference dataset built in consensus by senior surgeons.

Results: The algorithms obtained a mean area under the curve value of 0.98 on the quality assurance and the image characteristics tasks. They reached a mean difference for the predicted angles of 1.71° (standard deviation, 1.53°), similar to the surgeon average difference of 1.69° (standard deviation, 1.52°). The comparative analysis showed that the assistance of X-TKA allowed surgeons to gain 5% in accuracy and 12% in sensitivity in the detection of interface anomalies. Moreover, this study demonstrated a gain in repeatability for each single surgeon (Light's kappa +0.17), as well as a gain in the reproducibility between surgeons (Light's kappa +0.1).

Conclusion: This study highlights the benefit of using an intelligent artificial tool for a standardized interpretation of postoperative knee X-rays and indicates the potential for its use in clinical practice.

Keywords: artificial intelligence; image analysis; interface issue; neural networks; prosthesis alignment; total knee arthroplasty.

MeSH terms

  • Arthroplasty, Replacement, Knee* / methods
  • Artificial Intelligence
  • Humans
  • Knee Joint / diagnostic imaging
  • Knee Joint / surgery
  • Knee Prosthesis*
  • Osteoarthritis, Knee* / diagnostic imaging
  • Osteoarthritis, Knee* / surgery
  • Reproducibility of Results