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From variability to consistency: building a Kellgren-Lawrence gonarthrosis dataset
Salih Beyaz1, Sahika Betul Yayli2, Kutay Kılıç2
1Adana Turgut Noyan Research and Training Centre, Orthopedics and Traumatology Department, Baskent University, Adana, Turkey. sbeyaz@baskent.edu.tr.
Journal of Orthopaedic Surgery and Research
|October 24, 2025
Summary
Orthopedic surgeons demonstrated better agreement in Kellgren-Lawrence staging compared to radiologists. Grouping stages into early (KL ≤ 2) and advanced (KL ≥ 3) improved reliability for AI dataset development.
Area of Science:
- Radiology and Orthopedics
- Artificial Intelligence in Healthcare
- Medical Imaging Analysis
Background:
- Kellgren-Lawrence (KL) staging is crucial for assessing gonarthrosis severity.
- Variability in KL staging among healthcare professionals can impact clinical decision-making and AI development.
- Standardized datasets are essential for reliable AI-driven solutions in osteoarthritis management.
Purpose of the Study:
- To evaluate interobserver variability in Kellgren-Lawrence (KL) staging between radiologists and orthopedic surgeons.
- To compare the reliability of KL staging on a 0-4 scale versus a two-category system (early/advanced).
- To inform the creation of unbiased datasets for AI-driven gonarthrosis solutions.
Main Methods:
- Retrospective analysis of 15,159 knee radiographs from patients aged 18+.
- Independent KL staging by two radiologists and two orthopedic surgeons.
- Consensus evaluation by two experienced orthopedic specialists.
- Assessment using both a 0-4 scale and a two-category (KL ≤ 2 vs. KL ≥ 3) classification.
Main Results:
- Orthopedic surgeons showed fair to moderate agreement (κ=0.18-0.307) with experts, while radiologists showed slight to fair agreement (κ=0.085-0.172) on the 0-4 KL scale.
- The two-category classification (early/advanced) significantly improved inter-rater reliability for orthopedic surgeons (κ=0.637-0.692) compared to radiologists (κ=0.183-0.230).
- Highest intra-professional agreement was between two radiologists (κ=0.55) on the 0-4 scale and two orthopedic surgeons (κ=0.642) in the two-category system.
Conclusions:
- Orthopedic surgeons exhibit higher interobserver agreement in KL staging, especially for advanced stages (KL ≥ 3), compared to radiologists.
- Classifying KL stages into early (KL ≤ 2) and advanced (KL ≥ 3) groups enhances reliability.
- This simplified classification aids in developing standardized, unbiased datasets for AI in gonarthrosis management.
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