Ann Rheum Dis 1998;57:624-629 ( October )

Concise reports

Variability in knee radiographing: implication for definition of radiological progression in medial knee osteoarthritis Philippe Ravaud,^a Bruno Giraudeau,^b Guy-Robert Auleley,^a Jean-Luc Drape,^a Benoit Rousselin,^c Laurence Paolozzi,^d Claude Chastang,^b Maxime Dougados^a

^a Department of Rheumatology and Department of Radiology, Cochin Hospital and René Descartes University, Paris, France, ^b Department of Biostatistics and Medical Computing, Saint-Louis Hospital, Paris, France, ^c Department of Radiology, Ambroise Paré Hospital, Boulogne, France, ^d Cassenne Laboratories, Puteaux, France

Correspondence to: Dr P Ravaud, Clinique de Rhumatologie, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75674 Paris cedex 14, France.

Accepted for publication 23 July 1998

OBJECTIVES(1) To assess reproducibility of medial knee joint space width (JSW) measurement in healthy subjects and osteoarthritic (OA) patients. (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 radiographed in the weightbearing, anteroposterior extended view, twice, two weeks apart, using three different radiographic procedures: (a) without guidelines, (b) with guidelines and without fluoroscopy, (c) with guidelines and fluroroscopy. (2) Knee OA patients: in the second part of the study, 36 knees of OA patients 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.
RESULTSStandard deviation (SD) of differences in JSW measurement between two sets of knee radiographs in healthy subjects were 0.66 mm for radiography performed without guidelines, 0.37 mm for radiography performed with guidelines and 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 fluoroscopy. A minimal relevant change in JSW between two radiographs performed 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 guidelines and fluoroscopy, respectively. When radiographs are taken with guidelines and without fluoroscopy, the change must be at least 0.73 mm. A similar figure, 0.64 mm was observed in knee OA patients.
CONCLUSIONDefinition of radiological progression varies greatly according to the radiographic procedure chosen. Use of guidelines reduces the threshold of progression required to consider that change between two measures is relevant.

Keywords: radiography; knee; osteoarthritis

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© 1998 by Annals of the Rheumatic Diseases
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