Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Associating an anteroposterior (AP) extended-knee X-ray with a semiflexed AP or posteroanterior (PA) view is considered the gold standard for radiologically diagnosing tibiofemoral osteoarthritis (OA), but limited data only support the diagnostic value of this approach. Our objective is to compare the contribution of these different views to diagnosis.
Methods: From 2007 to 2009, a population-based two-phase prevalence study was conducted to create the KHOALA cohort (Knee and Hip OA long-term assessment) (1). It was conducted in 6 French centers (Amiens, Brest, Nancy, Toulouse, Nice, and Paris). For the current work, we included the first 350 participants aged 40 to 75 years old regardless of their Kellgren Laurence (KL) stage.
A first reading of Schuss + standard AP views was carried out by an expert rheumatologist (BM). A second reading of Schuss X rays only was carried out remotely, (blinded to the results of the first lecture), by the same examiner. Analysis focused on the comparison of KL stage of each knee, as well as on osteophytes detection and localization: Medial Condyle (MC), Lateral (LC), Medial Tibial Plateau (MTP) or Lateral (LTP) (all ranked from 0 to 3), Joint space narrowing (JSN) (ranked from 0 to 4) and bone sclerosis (MC, LC, MTP, LTP).
Results: 350 subjects were included. Mean age was 58 years (8.6), Body Mass Index (BMI) was 29.8 (5.4). Time between the two readings was 2 years.
|
|
Standard AP + Schuss |
Schuss |
Standing AP view
|
|||
|
KL stage |
Right Knee n (%) |
Left Knee n (%) |
Right Knee n (%) |
Left Knee n (%) |
Right knee n (%) |
Left knee n (%) |
|
KL≥ 2 |
110 (31) |
87 (25) |
83 (24) |
64 (18) |
95 (27) |
72 (21) |
|
Osteophytes |
|
|
|
|
|
|
|
MC |
31 (9) |
30 (9) |
32 (9) |
32 (9) |
29 (8) |
28 (8) |
|
LC |
10 (3) |
12 (3) |
20(6) |
17 (5) |
17 (5) |
10 (3) |
|
MTP |
39 (11) |
35 (10) |
38 (11) |
28 (8) |
22 (9) |
32 (9) |
|
LTP |
25 (7) |
23 (6) |
21 (6) |
16 (5) |
21 (6) |
18 (5) |
|
JSN |
71 (20) |
60 (17) |
60 (17) |
52 (15) |
42 (12) |
37 (11) |
Comparing two readings showed a significantly higher proportion of KL ≥ 2 patients when the two X-ray views were combined (right knee: p < 0.0001; left knee: p < 0.001). In contrast, a more in-depth analysis taking into account JSN, osteophytes, and bone condensation did not confirm this difference. A comparison of Schuss versus AP alone demonstrated the superiority of the Schuss view in evaluating JSN (p=0.0001 and p=0.0001) with no difference in osteophyte detection. A lower rate of JSN detection with Schuss view X-ray alone in high-BMI patients is suggested.
Conclusion: In our study, Schuss is superior to AP view to detect knee OA. Adding an AP view to the Schuss view leads to higher number of grades 1(not confirmed osteophytes). The marked differences in KL are probably due to KL scale limitations. No differences appear in JSN and osteophyte detection, the main features of OA. Due to the higher cost and radiation exposure involved in associating views, the Schuss view alone tends to be used for OA diagnosis in the general population.
Ref.
(1) Guillemin F, Rat AC, Roux CH, Fautrel B, Mazieres B, Chevalier X, Euller-Ziegler L, Fardellone P, Verrouil E, Morvan J, Pouchot J, Coste J, Saraux A; KHOALA cohort study. The KHOALA cohort of knee and hip osteoarthritis in France. Joint Bone Spine. 2012 ;79(6):597-603.
Disclosure:
C. Roux,
None;
B. Mazieres,
None;
E. Verrouil,
None;
A. C. Rat,,
None;
P. Fardellone,
None;
B. Fautrel,
None;
J. Pouchot,
None;
A. Saraux,
None;
F. Guillemin,
None;
L. Euller Ziegler,
None;
J. Coste,
None.
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