European Radiology

, Volume 14, Issue 9, pp 1568–1573 | Cite as

Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis

  • Manish Kothari
  • Ali Guermazi
  • Gabriele von Ingersleben
  • Yves Miaux
  • Martine Sieffert
  • Jon E. Block
  • Randall Stevens
  • Charles G. Peterfy


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° 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.


Knee Osteoarthritis Radiography Joint space width 



This image acquisition for this study was funded by Hoffman-La Roche. Authors thank Melissa M. Ta from Synarc for providing the drawings.


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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Manish Kothari
    • 1
  • Ali Guermazi
    • 2
  • Gabriele von Ingersleben
    • 2
  • Yves Miaux
    • 2
  • Martine Sieffert
    • 1
  • Jon E. Block
    • 1
  • Randall Stevens
    • 3
  • Charles G. Peterfy
    • 1
  1. 1.Department of Scientific Client ServicesSynarc, Inc.San FranciscoUSA
  2. 2.Department of Reading ServicesSynarc, Inc.San FranciscoUSA
  3. 3.Hoffmann-La RocheNutleyUSA

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