Extended report
Radiographic assessment of hip osteoarthritis progression: impact
of reading procedures for longitudinal studies
Guy-Robert Auleleya, Bruno Giraudeaub, Maxime Dougadosa, Philippe Ravauda
a Faculté
de Médecine Cochin Port-Royal and Clinique de Rhumatologie, Hôpital
Cochin, AP-HP, Paris, France, b Centre de Recherche Clinique,
Faculté de Médecine, Tours, France
Correspondence to: Dr Ph Ravaud, Clinique de Rhumatologie, Hôpital Cochin, 27 rue du faubourg Saint Jacques, 75014 Paris, France Email: philippe,Ravaud{at}cch.ap-hop-paris-fr
Accepted for publication 25 February 2000
OBJECTIVE
To compare
radiographic reading procedures and evaluate their impact on sample
size in hip osteoarthritis (OA) longitudinal studies.
METHODSPelvic
radiographs performed twice, three years apart, in 104 patients with
hip OA were read by a single reader using the Kellgren and Lawrence
system, joint space narrowing scale, and joint space width (JSW).
Reading procedures were (a) films read as
single radiographs, (b) films grouped by
patient but read in random order, (c) films
grouped by patient and chronologically ordered, all with landmarks for
JSW measurements, (d) films read as single
radiographs, without landmarks for JSW measurements. JSW was measured
at the narrowest point with a 0.1 mm graduated magnifying glass.
RESULTS More Kellgren
and Lawrence or joint space narrowing grades were modified respectively
with the single (42% and 37%) than with the paired (32% and 23%) or
chronologically ordered (34% and 29%) reading procedures. Variability
of JSW progression was principally related to mean progression (88.3%)
and landmarks (almost 10%). Standardised response means were 
0.71
with the paired reading procedure with landmarks, 0.68 with the
single reading procedure with landmarks, 0.65 with the single
reading procedure without landmarks. With landmarks, 10% more patients would be needed using single than paired reading. Using single reading,
10% more patients would be needed without landmarks than with landmarks.
CONCLUSIONKellgren
and Lawrence grading seems to be influenced by the reading procedure,
as is joint space narrowing grading, for assessing hip OA. Paired
reading procedure with landmarks for JSW should be recommended in
longitudinal studies.
© 2000 by Annals of the Rheumatic Diseases
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