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

  • Musculoskeletal
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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.

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Acknowledgment

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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Authors and Affiliations

  1. Department of Scientific Client Services, Synarc, Inc., 575 Market Street, 17th Floor, San Francisco, CA 94105, USA

    Manish Kothari, Martine Sieffert, Jon E. Block & Charles G. Peterfy

  2. Department of Reading Services, Synarc, Inc., 575 Market Street, 17th Floor, San Francisco, CA 94105, USA

    Ali Guermazi, Gabriele von Ingersleben & Yves Miaux

  3. Hoffmann-La Roche, Nutley, NJ, USA

    Randall Stevens

Authors
  1. Manish Kothari
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  2. Ali Guermazi
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  3. Gabriele von Ingersleben
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  4. Yves Miaux
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  5. Martine Sieffert
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  6. Jon E. Block
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  7. Randall Stevens
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  8. Charles G. Peterfy
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Correspondence to Ali Guermazi.

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Kothari, M., Guermazi, A., von Ingersleben, G. et al. Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol 14, 1568–1573 (2004). https://doi.org/10.1007/s00330-004-2312-6

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  • DOI: https://doi.org/10.1007/s00330-004-2312-6

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