Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2022; 13(6): 603-614
Published online Jun 18, 2022. doi: 10.5312/wjo.v13.i6.603
Evaluation of artificial intelligence models for osteoarthritis of the knee using deep learning algorithms for orthopedic radiographs
Anjali Tiwari, Murali Poduval, Vaibhav Bagaria
Anjali Tiwari, Vaibhav Bagaria, Department ofOrthopedics, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai 400004, India
Murali Poduval, Lifesciences Engineering, Tata Consultancy Services, Mumbai 400096, India
Vaibhav Bagaria, Department ofOrthopedics, Columbia Asia Hospital, Mumbai 400004, India
Author contributions: Tiwari A analyzed and evaluated the feasibility and accuracy of the artificial intelligence models with the interpretation of data; Poduval M was involved in critically revising the draft; Bagaria V designed and conceptualized the study and revised the manuscript for important intellectual content; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Scientific Advisory Committee and Institutional Ethics Committee of Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India (Approval No. HNH/IEC/2021/OCS/ORTH/56).
Informed consent statement: Informed consent was waived since the data were retrospectively collated anonymously from routine clinical practice.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vaibhav Bagaria, FCPS, MBBS, MS, Director, Department of Orthopedics, Sir H. N. Reliance Foundation Hospital and Research Centre, Raja Rammohan Roy Road, Prarthana Samaj, Mumbai 400004, India. bagariavaibhav@gmail.com
Received: November 30, 2021
Peer-review started: November 30, 2021
First decision: January 11, 2022
Revised: January 20, 2022
Accepted: May 13, 2022
Article in press: May 13, 2022
Published online: June 18, 2022
Processing time: 198 Days and 15.7 Hours
Abstract
BACKGROUND

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.

AIM

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.

METHODS

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.

RESULTS

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%.

CONCLUSION

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.

Keywords: Osteoarthritis; Artificial intelligence; Knee; Computer vision; Machine leaning; Deep learning

Core Tip: In this study, we evaluated different machine learning models to determine which model is best to classify the severity of knee osteoarthritis using the Kellgren-Lawrence grading system. The image set was composed of radiographs of native knees, in anteroposterior and lateral views. The radiographic exams were annotated by experts and tagged according to Kellgren-Lawrence grades. The findings of this study will pave the way for future development in the field, with the development of more accurate models and tools that can improve medical image classification by machine learning and will give valuable insight into orthopedic disease pathology.