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Femoro-tibial knee osteoarthritis: One or two X-rays? Results from a population-based study

Abstract : OBJECTIVE:Our objective was to compare the use of both anteroposterior (AP) extended-knee X-ray and semi-flexed X-ray (current gold standard) versus the use of semi-flexed X-ray alone to detect femoro-tibial osteoarthritis (OA).METHODS:Individuals 40 to 75 years of age with symptomatic hip and/or knee OA (Kellgren/Lawrence [KL] score≥2) were recruited using a multiregional prevalence survey in France. Both AP and schuss X-rays were performed and read; two years later, the same examiner, blinded to the results of the first reading, performed a second reading of the schuss X-ray. We compared the KL stages of each knee and analyzed osteophyte detection and localization, joint space narrowing (JSN), and the relationship to obesity.RESULTS:The analysis included 350 participants with OA of various stages. Comparing the two readings showed that a higher proportion of patients had KL≥2 when the two X-ray views were combined (right knee: P<0.0001; left knee: P<0.001). There were no differences when using the schuss X-ray alone versus in combination with an AP X-ray in terms of detecting JSN, osteophytes. A comparison of schuss X-ray alone versus AP X-ray alone demonstrated the superiority of the schuss view for evaluating JSN (P=0.0001 and P=0.0001) and no difference in osteophyte detection.CONCLUSION:Our study shows that the schuss view alone was sufficient for detecting knee osteophytes and JSN. Using one X-ray rather than two will reduce medical costs and irradiation burden. Using two views seems preferable for epidemiological studies.
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Christian-Hubert Roux, Bernard Mazieres, Evelyne Verrouil, Anne-Christine Rat, Patrice Fardellone, et al.. Femoro-tibial knee osteoarthritis: One or two X-rays? Results from a population-based study. Joint Bone Spine, Elsevier Masson, 2016, 83 (1), pp.37-42. ⟨10.1016/j.jbspin.2015.04.013⟩. ⟨hal-01813213⟩



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