From Kellgren-Lawrence to Calcium Pyrophosphate Crystal Deposition: A Soft-Labelling Framework for Knee Osteoarthritis Assessmen

Grading knee osteoarthritis (KOA) on plain radiographs is poorly reproducible across readers. A single-grade disagreement on the Kellgren-Lawrence (KL) scale can alter surgical management or redirect a patient from conservative therapy to intra-articular injection. Meanwhile, deep learning models that outperform human readers often offer no explanation for their decisions. We present Knee-xRAI, a pipeline that decomposes the grading process by mimicking clinical radiological workflows. It independently measures joint space narrowing (JSN), osteophytes, and subchondral sclerosis, then combines these findings into an explainable KL grade. Specifically, a U-Net++ architecture quantifies JSN via contour segmentation, an SE-ResNet-50 multi-task network grades osteophytes per anatomical site on the OARSI scale, and a hybrid texture-CNN detects binary sclerosis. This pipeline yields a 50-dimensional feature vector evaluated via an XGBoost-SHAP classifier (Path A, audit) and a ConvNeXt hybrid predictor (Path B, deployed). On 8,260 OAI-derived radiographs, the JSN module achieved a Dice score of 0.8909 and an mJSW ICC of 0.8674. Path A reached a QWK of 0.6294 and an AUC of 0.8046, confirming the structured feature vector carries substantial diagnostic signal. Path B achieved a QWK of 0.8436 and an AUC of 0.9017. SHAP analysis identifies JSN as the dominant feature, with osteophytes adding a consistent increment and sclerosis contributing marginally. Removing JSN evidence collapses KL3-KL4 recall while early grades remain intact, aligning with the KL diagnostic criteria. Knee-xRAI grounds every prediction in an auditable chain of measured radiographic findings, providing clinical transparency at the point of care.

Knee osteoarthritis (KOA) is among the musculoskeletal disorders that considerably restrict joint mobility, cause severe chronic pain and impact negatively on quality life. It is one of the persistent health issues worldwide. Generally, subjectivity and inter-observer variability undermine conventional practices and evaluation process that are adopted to address such health issues. Hence precise and timely diagnosis would be one of the effective ways for the assessment of its severity. This paper proposes an automated diagnostic approach for severity grading of KOA by blending a deep learning convolutional neural network (CNN) with a device-based inference platform powered by TensorFlow Lite. It proposes a model based on the ResNet-18 convolutional neural network. The designed model is trained on publicly available database. Through a transfer learning approach obtained knee images are first classified into five Kellgren-Lawrence (KL) grades. Further the developed model is optimised. During the training of the model test accuracy of 94.48% with stable convergence has been achieved. Subsequently the optimised model transformed into a lightweight TensorFlow Lite format, facilitating seamless deployment on resource-constrained devices. The designed model is capable enough to operate in the environment having no continuous internet connectivity. Also, an auxiliary Large Language Model (Gemini-2.0-flash) is applied to generate structured interpretive findings like potential symptoms, risk factors, and preventive majors etc. The LLM component functions as interface without influencing the classification process. The proposed model articulates the feasibility of an on-device, interpretable decision-support tools for early diagnosis and improve accessibility to Artificial Intelligence (AI)-assisted knee screening tool.

Knee osteoarthritis (OA) assessment involves a natural but often underused label hierarchy: a coarse binary OA decision and a fine-grained Kellgren--Lawrence (KL) severity grade. Existing deep learning studies commonly treat these targets as separate classification problems, either reducing OA assessment to disease presence or directly optimizing noisy ordinal KL labels. In this work, we ask whether this clinical hierarchy can serve as a representation-level supervisory prior. Rather than introducing a complex architecture, we use a deliberately simple dual-head model with a shared encoder and two task-specific heads as a probe of hierarchical supervision. We compare single-OA, single-KL, and dual-head training across multiple 3D backbones under the same test protocol. Beyond standard classification metrics, we perform paired statistical comparisons, analyze latent severity-axis geometry, and examine saliency overlap with cartilage regions. The results show that dual-head supervision produces backbone-dependent gains, with clear improvements in KL-related metrics for selected backbones. More importantly, the gains are accompanied by a more ordered coarse-to-fine latent organization and, for responsive backbones, stronger anatomical alignment of saliency with cartilage. These findings suggest that even simple hierarchical dual-head supervision can reshape disease representations under noisy coarse/fine labels, providing a useful inductive bias for OA diagnosis and severity grading.