Fixed-flexion Radiography of the Knee Provides Reproducible Joint Space Width Measurements in Osteoarthritis

Overview

Journal Eur Radiol

Specialty Radiology

Date 2004 May 20

PMID 15150666

Citations 117

Authors

Manish Kothari

Ali Guermazi

Gabriele von Ingersleben

Yves Miaux

Martine Sieffert

Jon E Block

Randall Stevens

Charles G Peterfy

Affiliations

Soon will be listed here.

Abstract

The validity of a non-fluoroscopic fixed-flexion radiographic acquisition and analysis protocol for measurement of joint space width (JSW) in knee osteoarthritis is determined. A cross-sectional study of 165 patients with documented knee osteoarthritis participating in a multicenter, prospective study of chondroprotective agents was performed. All patients had posteroanterior, weight-bearing, fixed-flexion radiography with 10 degrees caudal beam angulation. A specially designed frame (SynaFlexer) was used to standardize the positioning. Minimum medial and lateral JSW were measured manually and twice by an automated analysis system to determine inter-technique and intra-reader concordance and reliability. A random subsample of 30 patients had repeat knee radiographs 2 weeks apart to estimate short-term reproducibility using automated analysis. Concordance between manual and automated medial JSW measurements was high (ICC=0.90); lateral compartment measurements showed somewhat less concordance (ICC=0.72). There was excellent concordance between repeated automated JSW measurements performed 6 months apart for the medial (ICC=0.94) and lateral (ICC=0.86) compartments. Short-term reproducibility for the subsample of 30 cases with repeat acquisitions demonstrated an average SD of 0.14 mm for medial JSW (CV=4.3%) and 0.23 mm for lateral JSW (CV=4.0%). Fixed-flexion radiography of the knee using a positioning device provides consistent, reliable and reproducible measurement of minimum JSW in knee osteoarthritis without the need for concurrent fluoroscopic guidance.

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References

Mazzuca S, Brandt K, Buckland-Wright J, Buckwalter K, Katz B, Lynch J . Field test of the reproducibility of automated measurements of medial tibiofemoral joint space width derived from standardized knee radiographs. J Rheumatol. 1999; 26(6):1359-65. View

Vignon E, Conrozier T, Piperno M, Richard S, Carrillon Y, Fantino O . Radiographic assessment of hip and knee osteoarthritis. Recommendations: recommended guidelines. Osteoarthritis Cartilage. 1999; 7(4):434-6. DOI: 10.1053/joca.1999.0235. View

Bartko J . The intraclass correlation coefficient as a measure of reliability. Psychol Rep. 1966; 19(1):3-11. DOI: 10.2466/pr0.1966.19.1.3. View

Brandt K, Fife R, Braunstein E, Katz B . Radiographic grading of the severity of knee osteoarthritis: relation of the Kellgren and Lawrence grade to a grade based on joint space narrowing, and correlation with arthroscopic evidence of articular cartilage degeneration. Arthritis Rheum. 1991; 34(11):1381-6. DOI: 10.1002/art.1780341106. View

Reginster J, Deroisy R, Rovati L, Lee R, Lejeune E, Bruyere O . Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001; 357(9252):251-6. DOI: 10.1016/S0140-6736(00)03610-2. View

Ravaud P, Chastang C, Auleley G, Giraudeau B, Royant V, Amor B . Assessment of joint space width in patients with osteoarthritis of the knee: a comparison of 4 measuring instruments. J Rheumatol. 1996; 23(10):1749-55. View

Buckland-Wright J, Macfarlane D, Lynch J, Jasani M, Bradshaw C . Joint space width measures cartilage thickness in osteoarthritis of the knee: high resolution plain film and double contrast macroradiographic investigation. Ann Rheum Dis. 1995; 54(4):263-8. PMC: 1005571. DOI: 10.1136/ard.54.4.263. View

Mazzuca S, Brandt K, Katz B . Is conventional radiography suitable for evaluation of a disease-modifying drug in patients with knee osteoarthritis?. Osteoarthritis Cartilage. 1997; 5(4):217-26. DOI: 10.1016/s1063-4584(97)80017-9. View

Altman R, Hochberg M, Murphy Jr W, Wolfe F, Lequesne M . Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage. 1995; 3 Suppl A:3-70. View

10.

Muller R, Buttner P . A critical discussion of intraclass correlation coefficients. Stat Med. 1994; 13(23-24):2465-76. DOI: 10.1002/sim.4780132310. View

11.

Buckland-Wright J, Wolfe F, Ward R, Flowers N, Hayne C . Substantial superiority of semiflexed (MTP) views in knee osteoarthritis: a comparative radiographic study, without fluoroscopy, of standing extended, semiflexed (MTP), and schuss views. J Rheumatol. 1999; 26(12):2664-74. View

12.

Lequesne M, Brandt K, Bellamy N, Moskowitz R, Menkes C, Pelletier J . Guidelines for testing slow acting drugs in arthritis--addendum. J Rheumatol. 1995; 22(7):1442. View

13.

Ravaud P, Giraudeau B, Auleley G, Drape J, Rousselin B, Paolozzi L . Variability in knee radiographing: implication for definition of radiological progression in medial knee osteoarthritis. Ann Rheum Dis. 1999; 57(10):624-9. PMC: 1752490. DOI: 10.1136/ard.57.10.624. View

14.

Messieh S, Fowler P, Munro T . Anteroposterior radiographs of the osteoarthritic knee. J Bone Joint Surg Br. 1990; 72(4):639-40. DOI: 10.1302/0301-620X.72B4.2380220. View

15.

Piperno M, Le Graverand M, Conrozier T, BOCHU M, Mathieu P, Vignon E . Quantitative evaluation of joint space width in femorotibial osteoarthritis: comparison of three radiographic views. Osteoarthritis Cartilage. 1999; 6(4):252-9. DOI: 10.1053/joca.1998.0118. View

16.

Ravaud P, Auleley G, Chastang C, Rousselin B, Paolozzi L, Amor B . Knee joint space width measurement: an experimental study of the influence of radiographic procedure and joint positioning. Br J Rheumatol. 1996; 35(8):761-6. DOI: 10.1093/rheumatology/35.8.761. View

17.

Lequesne M, Brandt K, Bellamy N, Moskowitz R, Menkes C, Pelletier J . Guidelines for testing slow acting drugs in osteoarthritis. J Rheumatol Suppl. 1994; 41:65-71; discussion 72-3. View

18.

Fife R, Brandt K, Braunstein E, Katz B, Shelbourne K, Kalasinski L . Relationship between arthroscopic evidence of cartilage damage and radiographic evidence of joint space narrowing in early osteoarthritis of the knee. Arthritis Rheum. 1991; 34(4):377-82. DOI: 10.1002/art.1780340402. View

19.

Mazzuca S, Brandt K, Buckwalter K, Lane K, Katz B . Field test of the reproducibility of the semiflexed metatarsophalangeal view in repeated radiographic examinations of subjects with osteoarthritis of the knee. Arthritis Rheum. 2002; 46(1):109-13. DOI: 10.1002/1529-0131(200201)46:1<109::aid-art10040>3.0.co;2-o. View

20.

Hochberg M, Altman R, Brandt K, Moskowitz R . Design and conduct of clinical trials in osteoarthritis: preliminary recommendations from a task force of the Osteoarthritis Research Society. J Rheumatol. 1997; 24(4):792-4. View