Radiographic knee alignment (KA) measurement is important for predicting joint health and surgical outcomes after total knee replacement. Traditional methods for KA measurements are manual, time-consuming and require long-leg radiographs. This study proposes a deep learning-based method to measure KA in anteroposterior knee radiographs via automatically localized knee anatomical landmarks. Our method builds on hourglass networks and incorporates an attention gate structure to enhance robustness and focus on key anatomical features. To our knowledge, this is the first deep learning-based method to localize over 100 knee anatomical landmarks to fully outline the knee shape while integrating KA measurements on both pre-operative and post-operative images. It provides highly accurate and reliable anatomical varus/valgus KA measurements using the anatomical tibiofemoral angle, achieving mean absolute differences ~1° when compared to clinical ground truth measurements. Agreement between automated and clinical measurements was excellent pre-operatively (intra-class correlation coefficient (ICC) = 0.97) and good post-operatively (ICC = 0.86). Our findings demonstrate that KA assessment can be automated with high accuracy, creating opportunities for digitally enhanced clinical workflows.

The Emory Knee Radiograph (MRKR) dataset is a large, demographically diverse collection of 503,261 knee radiographs from 83,011 patients, 40% of which are African American. This dataset provides imaging data in DICOM format along with detailed clinical information, including patient-reported pain scores, diagnostic codes, and procedural codes, which are not commonly available in similar datasets. The MRKR dataset also features imaging metadata such as image laterality, view type, and presence of hardware, enhancing its value for research and model development. MRKR addresses significant gaps in existing datasets by offering a more representative sample for studying osteoarthritis and related outcomes, particularly among minority populations, thereby providing a valuable resource for clinicians and researchers.

Knee pain is undoubtedly the most common musculoskeletal symptom that impairs quality of life, confines mobility and functionality across all ages. Knee pain is clinically evaluated by routine radiographs, where the widespread adoption of radiographic images and their availability at low cost, make them the principle component in the assessment of knee pain and knee pathologies, such as arthritis, trauma, and sport injuries. However, interpretation of the knee radiographs is still highly subjective, and overlapping structures within the radiographs and the large volume of images needing to be analyzed on a daily basis, make interpretation challenging for both naive and experienced practitioners. There is thus a need to implement an artificial intelligence strategy to objectively and automatically interpret knee radiographs, facilitating triage of abnormal radiographs in a timely fashion. The current work proposes an accurate and effective pipeline for autonomous detection, localization, and classification of knee joint area in plain radiographs combining the You Only Look Once (YOLO v3) deep convolutional neural network with a large and fully-annotated knee radiographs dataset. The present work is expected to stimulate more interest from the deep learning computer vision community to this pragmatic and clinical application.

The severity of knee osteoarthritis is graded using the 5-point Kellgren-Lawrence (KL) scale where healthy knees are assigned grade 0, and the subsequent grades 1-4 represent increasing severity of the affliction. Although several methods have been proposed in recent years to develop models that can automatically predict the KL grade from a given radiograph, most models have been developed and evaluated on datasets not sourced from India. These models fail to perform well on the radiographs of Indian patients. In this paper, we propose a novel method using convolutional neural networks to automatically grade knee radiographs on the KL scale. Our method works in two connected stages: in the first stage, an object detection model segments individual knees from the rest of the image; in the second stage, a regression model automatically grades each knee separately on the KL scale. We train our model using the publicly available Osteoarthritis Initiative (OAI) dataset and demonstrate that fine-tuning the model before evaluating it on a dataset from a private hospital significantly improves the mean absolute error from 1.09 (95% CI: 1.03-1.15) to 0.28 (95% CI: 0.25-0.32). Additionally, we compare classification and regression models built for the same task and demonstrate that regression outperforms classification.