Clinical applications of large language models in knee osteoarthritis: a systematic review
Bibliographic record
Abstract
Background and aims: Knee osteoarthritis (KOA) is a common chronic degenerative disease that significantly impacts patients' quality of life. With the rapid advancement of artificial intelligence, large language models (LLMs) have demonstrated potential in supporting medical information extraction, clinical decision-making, and patient education through their natural language processing capabilities. However, the current landscape of LLM applications in the KOA domain, along with their methodological quality, has yet to be systematically reviewed. Therefore, this systematic review aims to comprehensively summarize existing clinical studies on LLMs in KOA, evaluate their performance and methodological rigor, and identify current challenges and future research directions. Methods: Following the PRISMA guidelines, a systematic search was conducted in PubMed, Cochrane Library, Embase databases and Web of science for literature published up to June 2025. The protocol was preregistered on the OSF platform. Studies were screened using standardized inclusion and exclusion criteria. Key study characteristics and performance evaluation metrics were extracted. Methodological quality was assessed using tools such as Cochrane RoB, STROBE, STARD, and DISCERN. Additionally, the CLEAR-LLM and CliMA-10 frameworks were applied to provide complementary evaluations of quality and performance. Results: A total of 16 studies were included, covering various LLMs such as ChatGPT, Gemini, and Claude. Application scenarios encompassed text generation, imaging diagnostics, and patient education. Most studies were observational in nature, and overall methodological quality ranged from moderate to high. Based on CliMA-10 scores, LLMs exhibited upper-moderate performance in KOA-related tasks. The ChatGPT-4 series consistently outperformed other models, especially in structured output generation, interpretation of clinical terminology, and content accuracy. Key limitations included insufficient sample representativeness, inconsistent control over hallucinated content, and the lack of standardized evaluation tools. Conclusion: Large language models show notable potential in the KOA field, but their clinical application is still exploratory and limited by issues such as sample bias and methodological heterogeneity. Model performance varies across tasks, underscoring the need for improved prompt design and standardized evaluation frameworks. With real-world data and ethical oversight, LLMs may contribute more significantly to personalized KOA management. Systematic review registration: https://osf.io/jy4kz, identifier 10.17605/OSF.IO/479R8.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.076 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.014 |
| Bibliometrics | 0.012 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".