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Comparison of radiographic joint space width and magnetic resonance imaging for prediction of knee replacement: A longitudinal case-control study from the Osteoarthritis Initiative

  • Musculoskeletal
  • Published:
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Abstract

Objective

To evaluate whether change in fixed-location measures of radiographic joint space width (JSW) and cartilage thickness by MRI predict knee replacement.

Methods

Knees replaced between 36 and 60 months’ follow-up in the Osteoarthritis Initiative were each matched with one control by age, sex and radiographic status. Radiographic JSW was determined from fixed flexion radiographs and subregional femorotibial cartilage thickness from 3 T MRI. Changes between the annual visit before replacement (T0) and 2 years before T0 (T-2) were compared using conditional logistic regression.

Results

One hundred and nineteen knees from 102 participants (55.5 % women; age 64.2 ± 8.7 [mean ± SD] years) were studied. Fixed-location JSW change at 22.5 % from medial to lateral differed more between replaced and control knees (case-control [cc] OR = 1.57; 95 % CI: 1.23–2.01) than minimum medial JSW change (ccOR = 1.38; 95 % CI: 1.11–1.71). Medial femorotibial cartilage loss displayed discrimination similar to minimum JSW, and central tibial cartilage loss similar to fixed-location JSW. Location-independent thinning and thickening scores were elevated prior to knee replacement.

Conclusions

Discrimination of structural progression between knee pre-placement cases versus controls was stronger for fixed-location than minimum radiographic JSW. MRI displayed similar discrimination to radiography and suggested greater simultaneous cartilage thickening and loss prior to knee replacement.

Key Points

• Fixed-location JSW predicts surgical knee replacement more strongly than minimum JSW.

• MRI predicts knee replacement with similar accuracy to radiographic JSW.

• MRI reveals greater cartilage thinning and thickening prior to knee replacement.

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Acknowledgments

The authors thank the following operators at Chondrometrics GmbH: Gudrun Goldmann, Linda Jakobi, Manuela Kunz, Tanja Killer, Dr. Susanne Maschek, Jana Matthes, Tina Matthes, Sabine Mühlsimer, Julia Niedermeier, Annette Thebis, Dr. Barbara Wehr and Dr. Gabriele Zeitelhack for the segmentation of the magnetic resonance imaging data. Susanne Maschek is thanked for quality control readings of the segmentations.

Further, the authors would like to thank the readers of the fixed flexion radiographs at Boston University for the central KL grading, the OAI investigators, clinic staff and OAI participants at each of the OAI clinical centres for their contributions in acquiring the publicly available clinical and imaging data, the team at the OAI coordinating centre, particularly John Lynch, Maurice Dockrell and Jason Maeda, for their help in selecting images and verifying the knee replacements radiographically, and Stephanie Green and Hilary Peterson at Pittsburgh for administrative support.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The scientific guarantor of this publication is Dr. C. Kent Kwoh. This work was supported by the OAI, a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health and conducted by the OAI Study Investigators. Private funding partners of the OAI include Merck Research Laboratories; Novartis Pharmaceuticals Corporation; GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health.

The image analysis of this study was partly funded by a contract with the University of Pittsburgh (Pivotal OAI MRI Analyses POMA: NIH/NHLBI Contract No. HHSN2682010000 21C), by a vendor contract from the OAI coordinating centre at the University of California, San Francisco (N01-AR-2-2258), by an ancillary grant to the OAI held by Northwestern University (NIH/NIAMS R01 AR052918 [Sharma]) and by Novartis Pharma AG (Basel, Switzerland) and MerckKGaA (Darmstadt, Germany).

The statistical data analysis was funded by a contract with the University of Pittsburgh (Pivotal OAI MRI Analyses POMA: NIH/NHLBI Contract No. HHSN2682010000 21C) and the University of Pittsburgh Multidisciplinary Clinical Research Center (MCRC) for Rheumatic and Musculoskeletal Diseases (P60 AR054731).

The sponsors were not directly involved in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. The statistical analysis of the data was conducted by an independent statistical team at an academic institution (the University of Pittsburgh) which was independent of the commercial sponsors. No compensation or funding from a commercial sponsor was received for conducting the statistical analyses.

Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in:

Trajectory of cartilage loss within 4 years of knee replacement: a nested case-control study from the Osteoarthritis Initiative. Eckstein F, Boudreau RM, Wang Z, Hannon MJ, Wirth W, Cotofana S, Guermazi A, Roemer F, Nevitt M, John MR, Ladel C, Sharma L, Hunter DJ, Kwoh CK; OAI investigators.

Osteoarthritis Cartilage. 2014 Oct;22(10):1542-9. doi: 10.1016/j.joca.2014.04.016 . Epub 2014 Apr 30.

The authors of this manuscript declare relationships with the following companies: Chondrometrics GmbH, MerckSerono, Mariel Therapeutics, Medtronic, Pfizer, Eli Lilly, Glaxo Smith Kline, Centocor R&D, Wyeth, Novartis, Abbvie, Stryker, Synarc, Ampio, Boston Imaging Core Lab (BICL), Ortho-Trophix, Genzyme, TissueGene,Novartis Pharma AG, Merck KGaA, Allergan. Methodology: retrospective, case-control study diagnostic or prognostic study/observational, multicentre study.

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Authors and Affiliations

  1. Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg Austria & Chondrometrics GmbH, Ainring, Germany

    Felix Eckstein, Wolfgang Wirth & Sebastian Cotofana

  2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Robert Boudreau

  3. Division of Rheumatology and Clinical Immunology, University of Pittsburgh and Pittsburgh VAHS, Pittsburgh, PA, USA

    Zhijie Wang & Michael J. Hannon

  4. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Jeff Duryea

  5. Boston University School of Medicine and Boston Imaging Core Lab (BICL), LLC, Boston, MA, USA

    Ali Guermazi & Frank Roemer

  6. Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany

    Frank Roemer

  7. OAI Coordinating Ctr., UCSF, San Francisco, CA, USA

    Michael Nevitt

  8. Novartis Pharma AG, Basel, Swizerland

    Markus R. John

  9. Merck KGaA, Darmstadt, Germany

    Christoph Ladel

  10. Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Leena Sharma

  11. Royal North Shore Hospital & Institute of Bone and Joint Research, Kolling Institute, University Sydney, Sydney, NSW, Australia

    David J. Hunter

  12. Division of Rheumatology and the University of Arizona Arthritis Center, University of Arizona, Tucson, AZ, USA

    C. Kent Kwoh

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  1. Felix Eckstein
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Eckstein, F., Boudreau, R., Wang, Z. et al. Comparison of radiographic joint space width and magnetic resonance imaging for prediction of knee replacement: A longitudinal case-control study from the Osteoarthritis Initiative. Eur Radiol 26, 1942–1951 (2016). https://doi.org/10.1007/s00330-015-3977-8

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  • DOI: https://doi.org/10.1007/s00330-015-3977-8

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