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Artificial Intelligence Templating for Total Knee Arthroplasty: Using Standard Preoperative Knee Radiographs.

Nathan Whitsell1, Rosalee Zackula2, Tarun Bhargava1

  • 1The University of Kansas School of Medicine-Wichita, Wichita, Kansas, Department of Orthopaedics.

Kansas Journal of Medicine
|May 15, 2026
PubMed
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This study shows an artificial intelligence (AI) algorithm accurately predicts total knee arthroplasty (TKA) implant sizes from 2D knee radiographs. The AI's prediction accuracy improved over time, suggesting its value in preoperative planning.

Area of Science:

  • Orthopedic Surgery
  • Medical Imaging
  • Artificial Intelligence

Background:

  • Preoperative planning in total knee arthroplasty (TKA) is crucial for optimal outcomes.
  • Accurate templating of implant sizes is a key component of TKA preoperative planning.
  • Traditional methods rely on 2D radiographs, which have limitations in predicting 3D bone geometry.

Purpose of the Study:

  • To evaluate the accuracy of a novel artificial intelligence (AI) algorithm in predicting TKA implant sizes.
  • To assess the learning capabilities and improvement in accuracy of the AI algorithm over time.
  • To determine the potential of AI-driven 3D bone modeling for TKA preoperative planning.

Main Methods:

  • Retrospective analysis of 108 primary TKA cases.

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  • Utilized a novel AI algorithm to convert 2D knee radiographs into 3D bone models.
  • Compared AI-predicted implant sizes with actual implanted component sizes for accuracy assessment.
  • Evaluated AI learning by comparing accuracy in the first 50 patients versus the last 51 patients.

    • Main Results:

    • The AI algorithm achieved exact prediction accuracy of 40% for femoral and 41.5% for tibial components.
    • Allowing for a ±1 size difference, accuracy improved to 90% for femoral and 87% for tibial components.
    • The AI algorithm demonstrated significant improvement in accuracy over time for tibial components (p=0.0342) and a trend for femoral components (p=0.1719).

    Conclusions:

    • The AI-based algorithm accurately predicts TKA implant sizes from 2D radiographs.
    • The algorithm shows enhanced accuracy over time, indicating a learning capability.
    • This AI tool holds promise as a valuable aid for preoperative planning in total knee arthroplasty.