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Quantification of the Radiographic Joint Space Width of the Ankle

  • Original Article
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Quantification of joint space width of the ankle could provide information essential to evaluate the effects of potential disease-modifying agents and adverse effects of devices intended to ameliorate osteoarthritis elsewhere in the lower extremity. Current methods require proprietary software or have not been well validated; our purpose was to develop and assess the reliability of a digital joint space width quantification method using public access software. We studied 95 patients, asymptomatic in the ankles and without history of ankle trauma, but with symptomatic medial knee osteoarthritis, participating in an ongoing longitudinal trial. Weightbearing anteroposterior radiographs of the ankle and supine radiographs of the pelvis were assessed, and the narrowest medial and lateral tibiotalar joint space widths and hip joint space widths were measured using Image J software (US NIH, Bethesda, MD). Medial joint space widths were 2.56 ± 0.50 and 2.55 ± 0.48 mm, and lateral joint space widths were 2.45 ± 0.55 and 2.44 ± 0.52 mm, for right and left ankle, respectively. Coefficients of variation for repeat measurements by the same observer were 1.13% and 4.5%, and by different observers 7.30% and 7.27%, for medial and lateral joint space widths, respectively. Men had wider joint space widths than women when accounting for height. Joint space width of the ankle correlated with the joint space width of the hip and with height and weight, but not with age.

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References

  1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–1049.

    Article  PubMed  CAS  Google Scholar 

  2. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.

    PubMed  CAS  Google Scholar 

  3. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310.

    PubMed  CAS  Google Scholar 

  4. Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA. Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma. 2006;20:739–744.

    Article  PubMed  Google Scholar 

  5. Bruyere O, Richy F, Reginster JY. Three year joint space narrowing predicts long term incidence of knee surgery in patients with osteoarthritis: an eight year prospective follow up study. Ann Rheum Dis. 2005;64:1727–1730.

    Article  PubMed  CAS  Google Scholar 

  6. Cole AA, Margulis A, Kuettner KE. Distinguishing ankle and knee articular cartilage. Foot Ankle Clin. 2003;8:305–316.

    Article  PubMed  Google Scholar 

  7. Dougados M, Gueguen A, Nguyen M, Berdah L, Lequesne M, Mazieres B, Vignon E. Radiological progression of hip osteoarthritis: definition, risk factors and correlations with clinical status. Ann Rheum Dis. 1996;55:356–362.

    Article  PubMed  CAS  Google Scholar 

  8. Farsø Nielsen F, de Carvalho A. Dependence of ankle joint width on plantar flexion. Acta Radiol. 1989;30:554–556.

    Article  PubMed  Google Scholar 

  9. Fiirgaard B, Iversen JK, de Carvalho A. Width of the medial tibiotalar joint. Acta Radiol. 1997;38:520–522.

    PubMed  CAS  Google Scholar 

  10. Goker B, Doughan AM, Schnitzer TJ, Block JA. Quantification of progressive joint space narrowing in osteoarthritis of the hip: longitudinal analysis of the contralateral hip after total hip arthroplasty. Arthritis Rheum. 2000;43:988–994.

    Article  PubMed  CAS  Google Scholar 

  11. Goker B, Sancak A, Arac M, Shott S, Block JA. The radiographic joint space width in clinically normal hips: effects of age, gender and physical parameters. Osteoarthritis Cartilage. 2003;11:328–334.

    Article  PubMed  CAS  Google Scholar 

  12. Jonsson K, Fredin HO, Cederlund CG, Bauer M. Width of the normal ankle joint. Acta Radiol Diagn (Stockh). 1984;25:147–149.

    CAS  Google Scholar 

  13. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.

    Article  PubMed  CAS  Google Scholar 

  14. Lane NE, Nevitt MC, Hochberg MC, Hung YY, Palermo L. Progression of radiographic hip osteoarthritis over eight years in a community sample of elderly white women. Arthritis Rheum. 2004;50:1477–1486.

    Article  PubMed  Google Scholar 

  15. Maillefert JF, Nguyen M, Gueguen A, Berdah L, Lequesne M, Mazières B, Vignon E, Dougados M. Relevant change in radiological progression in patients with hip osteoarthritis. II. Determination using an expert opinion approach. Rheumatology (Oxford). 2002;41:148–152.

    Article  CAS  Google Scholar 

  16. Marijnissen AC, Vincken KL, Viergever MA, van Roy HL, Van Roermund PM, Lafeber FP, Bijlsma JW. Ankle images digital analysis (AIDA): digital measurement of joint space width and subchondral sclerosis on Standard radiographs. Osteoarthritis Cartilage. 2001;9:264–272.

    Article  PubMed  CAS  Google Scholar 

  17. Mody S, Jolly M, Kwasny MJ, Block JA. Patient reported outcomes and analgesia use in osteoarthritis of the knee. Osteoarthritis Cartilage. 2008;16:1294–1299.

    Article  PubMed  CAS  Google Scholar 

  18. Nevitt MC, Peterfy C, Guermazi A, Felson DT, Duryea J, Woodworth T, Chen H, Kwoh K, Harris TB. Longitudinal performance evaluation and validation of fixed-flexion radiography of the knee for detection of joint space loss. Arthritis Rheum. 2007;56:1512–1520.

    Article  PubMed  Google Scholar 

  19. Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J. 2005;25:44–46.

    PubMed  Google Scholar 

  20. Schmitt H, Lemke JM, Brocai DR, Parsch D. Degenerative changes in the ankle in former elite high jumpers. Clin J Sport Med. 2003;13:6–10.

    Article  PubMed  Google Scholar 

  21. Sharma L, Lou C, Cahue S, Dunlop DD. The mechanism of the effect of obesity in knee osteoarthritis: the mediating role of malalignment. Arthritis Rheum. 2000;43:568–575.

    Article  PubMed  CAS  Google Scholar 

  22. Tallroth K, Harilainen A, Kerttula L, Sayed R. Ankle osteoarthritis is associated with knee osteoarthritis: conclusions based on mechanical axis radiographs. Arch Orthop Trauma Surg. 2008;128:555–560.

    Article  PubMed  Google Scholar 

  23. Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of Ankle Osteoarthritis. Clin Orthop Relat Res. 2008 Oct 2. [Epub ahead of print].

  24. van Dijk CN, Tol JL, Verheyen CC. A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Am J Sports Med. 1997;25:737–745.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. School of Medicine, Department of Internal Medicine, Section of Rheumatology, Gazi University, Besevler, Ankara, 06500, Turkey

    Berna Goker MD & Mehmet D. Demirag MD

  2. Department of Orthopaedics and Traumatology, Ankara Diskapi Research Hospital, Ankara, Turkey

    Emel Gonen MD

  3. Departments of Biochemistry and Internal Medicine, Section of Rheumatology, Rush Medical College, Rush University Medical Center, 1725 W. Harrison Street, Suite 1017, Chicago, IL, 60612, USA

    Joel A. Block MD

Authors
  1. Berna Goker MD
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  2. Emel Gonen MD
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  3. Mehmet D. Demirag MD
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  4. Joel A. Block MD
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Corresponding author

Correspondence to Berna Goker MD.

Additional information

One or more of the authors have received funding from the National Institutes of Health, Bethesda, MD (NIH 1P50 AR048941) (JAB) and the Turkish Society for Education and Research in Rheumatology (RAED-Romatoloji Arastırma ve Egitim Dernegi) (BG).

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Gazi University and at Rush Medical College.

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Goker, B., Gonen, E., Demirag, M.D. et al. Quantification of the Radiographic Joint Space Width of the Ankle. Clin Orthop Relat Res 467, 2083–2089 (2009). https://doi.org/10.1007/s11999-009-0832-8

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  • DOI: https://doi.org/10.1007/s11999-009-0832-8

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