P. Ravaud et al., VARIABILITY IN KNEE RADIOGRAPHING - IMPLICATION FOR DEFINITION OF RADIOLOGICAL PROGRESSION IN MEDIAL KNEE OSTEOARTHRITIS, Annals of the Rheumatic Diseases, 57(10), 1998, pp. 624-629
Objectives - (1) To assess reproducibility of medial knee joint space
width (JSW) measurement in healthy subjects and osteoarthritic (OA) pa
tients. (2) To define minimal relevant radiological change in knee JSW
based on the reproducibility of its measurement. Patients and methods
- (1) Healthy volunteers: in the first part of the study, 20 knees of
healthy adult volunteers were radio-graphed in the weightbearing, ant
eroposterior extended view, twice, two weeks apart, using three differ
ent radiographic procedures: (a) without guidelines, (b) with guidelin
es and without fluoroscopy, (c) with guidelines and fluroroscopy. (2)
Knee OA patients: in the second part of the study, 36 knees of OA pati
ents were radiographed twice with guidelines and without fluoroscopy.
JSW was measured blindly using a graduated magnifying glass. Based on
the Bland and Altman graphic approach, cut off points defining minimal
relevant radiological change are proposed. Results - Standard deviati
on (SD) of differences in JSW measurement between two sets of knee rad
iographs in healthy subjects were 0.66 mm for radiography performed wi
thout guidelines, 0.37 mm for radiography performed with guidelines an
d without fluoroscopy, and 0.31 mm for radiography with guidelines and
fluoroscopy. SD of differences in JSW measurement in OA patients were
0.32 mm for radiography performed with guidelines and without fluoros
copy. A minimal relevant change in JSW between two radiographs perform
ed in healthy subjects can be defined by a change of at least 1.29 or
0.59 mm when radiographs are taken without guidelines, and with guidel
ines and fluoroscopy, respectively. When radiographs are taken with gu
idelines and without fluoroscopy, the change must be at least 0.73 mm.
A similar figure, 0.64 mm was observed in knee OA patients. Conclusio
n - Definition of radiological progression varies greatly according to
the radiographic procedure chosen. Use of guidelines reduces the thre
shold of progression required to consider that change between two meas
ures is relevant.