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
Musculoskeletal

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° 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.

Keywords

Knee Osteoarthritis Radiography Joint space width 

References

  1. 1.
    Hochberg MC, Altman RD, Brandt KD, Moskowitz RW (1997) Design and conduct of clinical trials in osteoarthritis: preliminary recommendations from a task force of the Osteoarthritis Research Society. J Rheumatol 24:792–794PubMedGoogle Scholar
  2. 2.
    Lequesne M, Brandt K, Bellamy N et al (1994) Guidelines for testing slow acting drugs in osteoarthritis. J Rheumatol [Suppl] 41:65–71; discussion 72–63PubMedGoogle Scholar
  3. 3.
    Lequesne M, Brandt K, Bellamy N et al (1995) Guidelines for testing slow acting drugs in arthritis—addendum. J Rheumatol 22:1442Google Scholar
  4. 4.
    Reginster JY, Deroisy R, Rovati LC et al (2001) Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 357:251–256CrossRefPubMedGoogle Scholar
  5. 5.
    Buckland-Wright JC, Macfarlane DG, Lynch JA, Jasani MK, Bradshaw CR (1995) Joint space width measures cartilage thickness in osteoarthritis of the knee: high resolution plain film and double contrast macroradiographic investigation. Ann Rheum Dis 54:263–268PubMedGoogle Scholar
  6. 6.
    Brandt KD, Fife RS, Braunstein EM, Katz B (1991) 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 34:1381–1386PubMedGoogle Scholar
  7. 7.
    Buckland-Wright JC, Macfarlane DG, Williams SA, Ward RJ (1995) Accuracy and precision of joint space width measurements in standard and macroradiographs of osteoarthritic knees. Ann Rheum Dis 54:872–880PubMedGoogle Scholar
  8. 8.
    Buckland-Wright JC, Wolfe F, Ward RJ, Flowers N, Hayne C (1999) 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 26:2664–2674PubMedGoogle Scholar
  9. 9.
    Fife RS, Brandt KD, Braunstein EM et al (1991) Relationship between arthroscopic evidence of cartilage damage and radiographic evidence of joint space narrowing in early osteoarthritis of the knee. Arthritis Rheum 34:377–382PubMedGoogle Scholar
  10. 10.
    Piperno M, Hellio Le Graverand MP, Conrozier T, Bochu M, Mathieu P, Vignon E (1998) Quantitative evaluation of joint space width in femorotibial osteoarthritis: comparison of three radiographic views. Osteoarthritis Cartilage 6:252–259CrossRefPubMedGoogle Scholar
  11. 11.
    Spector TD, Dacre JE, Harris PA, Huskisson EC (1992) Radiological progression of osteoarthritis: an 11 year follow-up study of the knee. Ann Rheum Dis 51:1107–1110PubMedGoogle Scholar
  12. 12.
    Mazzuca SA, Brandt KD, Katz BP (1997) Is conventional radiography suitable for evaluation of a disease-modifying drug in patients with knee osteoarthritis? Osteoarthritis Cartilage 5:217–226PubMedGoogle Scholar
  13. 13.
    Mazzuca SA, Brandt KD, Buckland-Wright JC et al (1999) Field test of the reproducibility of automated measurements of medial tibiofemoral joint space width derived from standardized knee radiographs. J Rheumatol 26:1359–1365PubMedGoogle Scholar
  14. 14.
    Ravaud P, Auleley GR, Chastang C et al (1996) Knee joint space width measurement: an experimental study of the influence of radiographic procedure and joint positioning. Br J Rheumatol 35:761–766PubMedGoogle Scholar
  15. 15.
    Ravaud P, Giraudeau B, Auleley GR et al (1998) Variability in knee radiographing: implication for definition of radiological progression in medial knee osteoarthritis. Ann Rheum Dis 57:624–629PubMedGoogle Scholar
  16. 16.
    Dacre JE, Huskisson EC (1989) The automatic assessment of knee radiographs in osteoarthritis using digital image analysis. Br J Rheumatol 28:506–510PubMedGoogle Scholar
  17. 17.
    Ravaud P, Chastang C, Auleley GR et al (1996) Assessment of joint space width in patients with osteoarthritis of the knee: a comparison of 4 measuring instruments. J Rheumatol 23:1749–1755PubMedGoogle Scholar
  18. 18.
    Messieh SS, Fowler PJ, Munro T (1990) Anteroposterior radiographs of the osteoarthritic knee. J Bone Joint Surg Br 72:639–640PubMedGoogle Scholar
  19. 19.
    Vignon E, Conrozier T, Piperno M, Richard S, Carrillon Y, Fantino O (1999) Radiographic assessment of hip and knee osteoarthritis. Recommendations: recommended guidelines. Osteoarthritis Cartilage 7:434–436CrossRefPubMedGoogle Scholar
  20. 20.
    Altman RD, Hochberg M, Murphy WA Jr, Wolfe F, Lequesne M (1995) Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage 3 [Suppl A]:3–70PubMedGoogle Scholar
  21. 21.
    Duryea J, Li J, Peterfy CG, Gordon C, Genant HK (2000) Trainable rule-based algorithm for the measurement of joint space width in digital radiographic images of the knee. Med Phys 27:580–591CrossRefPubMedGoogle Scholar
  22. 22.
    Peterfy C, Li J, Zaim S et al (2003) Comparison of fixed-flexion positioning with fluoroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: test-retest reproducibility. Skeletal Radiol 32:128–132PubMedGoogle Scholar
  23. 23.
    Bartko JJ (1966) The intraclass correlation coefficient as a measure of reliability. Psychol Rep 19:3–11PubMedGoogle Scholar
  24. 24.
    Muller R, Buttner P (1994) A critical discussion of intraclass correlation coefficients. Stat Med 13:2465–2476PubMedGoogle Scholar
  25. 25.
    Altman DG (1991) Practical statistics for medical research. Chapman & Hall, LondonGoogle Scholar
  26. 26.
    Mazzuca SA, Brandt KD, Buckwalter KA, Lane KA, Katz BP (2002) Field test of the reproducibility of the semiflexed metatarsophalangeal view in repeated radiographic examinations of subjects with osteoarthritis of the knee. Arthritis Rheum 46:109–113Google Scholar

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

Personalised recommendations