In The Journal of arthroplasty ; h5-index 65.0
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 expertise, 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 (SD) 1.53°), similar to the surgeon average difference of 1.69° (SD 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 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 reproducibility between surgeons (Light's kappa +0.1).
CONCLUSIONS : 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.
Bonnin Michel, Müller-Fouarge Florian, Estienne Théo, Bekadar Samir, Pouchy Charlotte, Ait SiSelmi Tarik
2023-Feb-27
Artificial Intelligence, Image analysis, Interface Issue, Neural Networks, Prosthesis Alignment, Total Knee Arthroplasty
