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Lenskjold A, Brejnebøl MW, Nybing JU, Rose MH, Gudbergsen H, Troelsen A, Moller A, Raaschou H, Boesen M. Constructing a clinical radiographic knee osteoarthritis database using artificial intelligence tools with limited human labor: A proof of principle. Osteoarthritis Cartilage 2024; 32:310-318. [PMID: 38043857 DOI: 10.1016/j.joca.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To create a scalable and feasible retrospective consecutive knee osteoarthritis (OA) radiographic database with limited human labor using commercial and custom-built artificial intelligence (AI) tools. METHODS We applied four AI tools, two commercially available and two custom-built tools, to analyze 6 years of clinical consecutive knee radiographs from patients aged 35-79 at the University of Copenhagen Hospital, Bispebjerg-Frederiksberg Hospital, Denmark. The tools provided Kellgren-Lawrence (KL) grades, joint space widths, patella osteophyte detection, radiographic view detection, knee joint implant detection, and radiographic marker detection. RESULTS In total, 25,778 knee radiographs from 8575 patients were included in the database after excluding inapplicable radiographs, and 92.5% of the knees had a complete OA dataset. Using the four AI tools, we saved about 800 hours of radiologist reading time and only manually reviewed 16.0% of the images in the database. CONCLUSIONS This study shows that clinical knee OA databases can be built using AI with limited human reading time for uniform grading and measurements. The concept is scalable temporally and across geographic regions and could help diversify further OA research by efficiently including radiographic knee OA data from different populations globally. We can prevent data dredging and overfitting OA theories on existing trite cohorts by including various gene pools and continuous expansion of new clinical cohorts. Furthermore, the suggested tools and applied approaches provide an ability to retest previous hypotheses and test new hypotheses on real-life clinical data with current disease prevalence and trends.
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Affiliation(s)
- Anders Lenskjold
- Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Radiological Artificial Intelligence Testcenter, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Mathias W Brejnebøl
- Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Radiological Artificial Intelligence Testcenter, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Janus U Nybing
- Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Radiological Artificial Intelligence Testcenter, Copenhagen, Denmark.
| | - Martin H Rose
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark.
| | - Henrik Gudbergsen
- The Parker Institute, University of Copenhagen, Copenhagen, Denmark; Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre & CAG ROAD - Research OsteoArthritis, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Anne Moller
- Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Henriette Raaschou
- Radiological Artificial Intelligence Testcenter, Copenhagen, Denmark; Department of Radiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark.
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Radiological Artificial Intelligence Testcenter, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Kim SE, Kim K, Lee MC, Han HS, Choi BS, Ro DH. An accurate method for measuring knee joint space width despite variations in beam projection angles. Knee 2023; 45:85-91. [PMID: 37925808 DOI: 10.1016/j.knee.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/09/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Assessing knee osteoarthritis (OA) severity through joint space width (JSW) measurements can be difficult due to anatomical variations, beam projection angle (BPA) errors, and patient posture during X-rays. Although various methods address these issues, a consensus on the reference point for accurate measurement is lacking. Therefore, establishing a precise evaluation method for JSW is imperative. METHODS Simulation on 30 knees with advanced OA to measure the JSW using digital reconstruction radiographs from computed tomography (CT) images was conducted. The distance between the medial femoral condyle and the anterior and posterior borders of the medial tibial plateau (represented by DAB and DPB, respectively) and their average (AVD) were used to evaluate JSW. Discrepancies were analyzed for various BPAs. Additionally, the reliability of measuring JSW using DAB, DPB, and AVD was evaluated in a proof-of-concept study on 100 knees using anteroposterior X-rays at three BPAs (neutral, 5° caudal, and 5° cephalic tilt). RESULTS In the simulation study, the AVD method had discrepancies below 1 mm from BPA 0° of 5°, 10° caudal tilt, and 5° cephalic tilt (P = 0.066, P = 0.120, and P < 0.001, respectively). However, the values of DAB and DPB showed significant discrepancies from BPA 0° (all over 1 mm and all P < 0.001) for various BPAs. The AVD measurement demonstrated the least discrepancy in JSW measurements based on BPA variations compared with DAB and DPB methods in the proof-of-concept study. CONCLUSIONS A simple method for accurately measuring joint space width, even when X-rays are taken at unintended angles can be applied in clinical practice.
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Affiliation(s)
- Sung Eun Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Keehyun Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung Sun Choi
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Voinier D, Neogi T, Arbeeva L, Voinier S, Master H, Thoma LM, Brunette M, Jakiela JT, White DK. Association of physical activity with loss of knee joint space width over two years: a compositional data analysis in the Osteoarthritis Initiative. Osteoarthritis Cartilage 2023; 31:1091-1100. [PMID: 36822497 PMCID: PMC10523474 DOI: 10.1016/j.joca.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 02/25/2023]
Abstract
OBJECTIVE There is continued debate as to how engaging in physical activity (PA), including moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary time (SED), affects one's risk for knee osteoarthritis (OA). Traditional regression methods do not account for the codependence of these categories of PA, whereby when one category increases, the others must decrease. Thus, we used compositional data analysis (CoDA) to examine time spent in each category of PA, or PA composition, and its association with loss of knee joint space width (JSW), a common indicator of knee OA progression. METHODS We performed a secondary analysis of data from a subset of participants in the Osteoarthritis Initiative. These participants had minute-by-minute activity data collected over 7 days at baseline; we then categorized each minute as MVPA, LPA, or SED. Our exposure, PA composition, represented min/day spent in each category. Our outcome, medial JSW loss, was the difference in medial tibiofemoral JSW from baseline to 2 years later. We employed CoDA, using an isometric log-ratio transformation, to examine the association of PA composition with medial JSW loss over 2 years, adjusting for potential confounders. RESULTS We included 969 participants (age: 64.5 years, 56% female, body mass index [BMI]: 28.8 kg/m2). Mean PA composition was: MVPA 9.1 min/day, LPA 278 min/day, SED 690 min/day. Per adjusted regression models, higher MVPA was not associated with greater medial JSW loss (β = -0.0005, P = 0.97), nor was LPA (β = 0.06, P = 0.27) or SED (β = -0.06, P = 0.21). CONCLUSION Using CoDA, PA composition was not associated with medial JSW loss over 2 years.
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Affiliation(s)
- D Voinier
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - T Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA.
| | - L Arbeeva
- University of North Carolina at Chapel Hill, Thurston Arthritis Research Center, Chapel Hill, NC, USA.
| | - S Voinier
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - H Master
- Vanderbilt University Medical Center, Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA.
| | - L M Thoma
- University of North Carolina at Chapel Hill, Division of Physical Therapy, Chapel Hill, NC, USA.
| | - M Brunette
- Evidation Health Inc, San Mateo, CA, USA.
| | - J T Jakiela
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - D K White
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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Li X, Roemer FW, Cicuttini F, MacKay JW, Turmezei T, Link TM. Early knee OA definition-what do we know at this stage? An imaging perspective. Ther Adv Musculoskelet Dis 2023; 15:1759720X231158204. [PMID: 36937824 PMCID: PMC10017942 DOI: 10.1177/1759720x231158204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/01/2023] [Indexed: 03/16/2023] Open
Abstract
While criteria for early-stage knee osteoarthritis (OA) in a primary care setting have been proposed, the role of imaging has been limited to radiography using the standard Kellgren-Lawrence classification. Standardized imaging and interpretation are critical with radiographs, yet studies have also shown that even early stages of radiographic OA already demonstrate advanced damage to knee joint tissues such as cartilage, menisci, and bone marrow. Morphological magnetic resonance imaging (MRI) shows degenerative damage earlier than radiographs and definitions for OA using MRI have been published though no accepted definition of early OA based on MRI is currently available. The clinical significance of structural abnormalities has also not been well defined, and the differentiation between normal aging and structural OA development remains a challenge. Compositional MRI of cartilage provides information on biochemical, degenerative changes within the cartilage matrix before cartilage defects occur and when cartilage damage is potentially reversible. Studies have shown that cartilage composition can predict cartilage loss and radiographic OA. However, while this technology is most promising for characterizing early OA it has currently limited clinical application. Better standardization of compositional MRI is required, which is currently work in progress. Finally, there has been renewed interest in computed tomography (CT) for assessing early knee OA as new techniques such as weight bearing and spectral CT are available, which may provide information on joint loading, cartilage, and bone and potentially have a role in better characterizing early OA. In conclusion, while imaging may have a limited role in diagnosing early OA in a primary care setting, there are advanced imaging technologies available, which detect early degeneration and may thus significantly alter management as new therapeutic modalities evolve.
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Affiliation(s)
- Xiaojuan Li
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Frank W. Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Flavia Cicuttini
- Musculoskeletal Unit, Monash University and Rheumatology, Alfred Hospital, Melbourne, VIC, Australia
| | - Jamie W. MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tom Turmezei
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 400 Parnassus Ave, A-367, San Francisco, CA 94143, USA
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Lockwood P, Mitchell M. An assessment of the dose and image quality difference between AP and PA positioned adult radiographic knee examinations. J Med Imaging Radiat Sci 2023; 54:123-134. [PMID: 36646545 DOI: 10.1016/j.jmir.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/10/2022] [Accepted: 12/07/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Knee X-rays are a standard examination to diagnose multiple conditions ranging from traumatic injuries, degeneration, and cancer. This study explores the differences between adult Anterior-Posterior (AP) and Posterior-Anterior (PA) weight-bearing knee examinations using absorbed radiation dose data and image quality. METHODS The study modelled and compared AP and PA knee X-ray radiation dose data using Monte-Carlo software, an Ion Chamber, and thermoluminescence dosemeters (TLDs) on a Rando phantom. Imaging parameters used were 66kVp, 4mAs, 100cm distance and 13 × 24cm collimation. The interval data analysis used a two-tailed t-test. The image quality of a sample of the AP and PA knee X-rays was assessed using Likert 5-point ordinal Image Quality Scoring (IQS) and the Wilcoxon matched pairs test. RESULTS Monte-Carlo modelling provided limited results; the Ion Chamber data for absorbed dose provided no variation between AP and PA positions but was similar to the AP TLD dose. The absorbed doses recorded with batches of TLDs demonstrated a 27.4% reduction (46.1μGy; p=0.01) in Skin Entrance Dose (ESD) and 9 - 58% dose reduction (1.6 - 16.4μGy; p=0.00-0.2) to the tissues and organs while maintaining diagnostic image quality (p=0.67). CONCLUSION The study has highlighted the various challenges of using different dosimetry approaches to measure absorbed radiation dose in extremity (knee) X-ray imaging. The Monte-Carlo simulated absorbed knee dose was overestimated, but the simulated body organ/tissue doses were lower than the actual TLD absorbed doses. The Ion Chamber absorbed doses did not differentiate between the positions. The TLD organ/tissue absorbed doses demonstrated a reduction in dose in the PA position compared to the AP position, without a detrimental effect on image quality. The study findings in laboratory conditions raise awareness of opportunities and potential to lower radiation dose, with further study replicated in a clinical site recommended.
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Affiliation(s)
- Paul Lockwood
- School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Kent, United Kingdom.
| | - Martin Mitchell
- School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Kent, United Kingdom; Imaging Department, Medway Maritime Hospital, Medway NHS Foundation Trust, Gillingham, Kent, United Kingdom
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Segal NA, Nevitt MC, Morales Aquino M, McFadden E, Ho M, Duryea J, Tolstykh I, Cheng H, He J, Lynch JA, Felson DT, Anderson DD. Improved responsiveness to change in joint space width over 24-month follow-up: comparison of 3D JSW on weight-bearing CT vs 2D JSW on radiographs in the MOST study. Osteoarthritis Cartilage 2023; 31:406-413. [PMID: 36526151 PMCID: PMC9974913 DOI: 10.1016/j.joca.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/13/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Radiographic joint space width (JSW) has been a standard for measuring knee osteoarthritis (OA) structural change. Limitations in the responsiveness of this approach might be overcome by instead measuring 3D JSW on weight-bearing CT (WBCT). This study compared the responsiveness of 3D JSW measurements using WBCT with the responsiveness of radiographic 2D JSW. DESIGN Standing, fixed-flexion knee radiographs (XR) and WBCT were acquired ancillary to the 144- and 168-month Multicenter Osteoarthritis Study visits. Tibiofemoral JSW was measured on both XR and WBCT. Responsiveness to change was defined by the standardized response mean (SRM) for change in JSW (1) at predetermined mediolateral locations (JSWx) on both modalities and (2) in the following subregions measured on WBCT images: central medial and lateral femur (CMF/CLF) and tibia (CMT/CLT), and anterior and posterior tibia (AMT/ALT, PMT/MLT). RESULTS Baseline and 24-month follow-up JSWx measurements were completed for 265 participants (58.1% women). Responsiveness of 3D JSWx for medial tibiofemoral compartment on coronal WBCT (SRM range: -0.18, -0.24) exceeded that for 2D JSWx (-0.10, -0.16). Responsiveness of 3D JSW subregional mean (-0.06, -0.36) and maximal (-1.14, -1.75) CMF and CMT and maximal CLF/CLT 3D JSW changes were statistically significantly greater in comparison with respective medial and lateral 2D JSWx (P ≤ 0.002). CONCLUSIONS Subregional 3D JSW on WBCT is substantially more responsive to 24-month changes in tibiofemoral joint structure compared to radiographic measurements. Use of subregional 3D JSW on WBCT could enable improved detection of OA structural progression over a 24-month duration in comparison with measurements made on XR.
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Affiliation(s)
- N A Segal
- University of Kansas Medical Center, Kansas City, KS, USA; The University of Iowa, Iowa City, IA, USA.
| | - M C Nevitt
- University of California-San Francisco, San Francisco, CA, USA
| | | | - E McFadden
- The University of Iowa, Iowa City, IA, USA
| | - M Ho
- The University of Iowa, Iowa City, IA, USA
| | - J Duryea
- Harvard University, Cambridge, MA, USA
| | - I Tolstykh
- University of California-San Francisco, San Francisco, CA, USA
| | - H Cheng
- University of Kansas Medical Center, Kansas City, KS, USA
| | - J He
- University of Kansas Medical Center, Kansas City, KS, USA
| | - J A Lynch
- University of California-San Francisco, San Francisco, CA, USA
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Kim MS, Koh IJ, Choi KY, Kim BS, In Y. Changes in joint space width over time and risk factors for deterioration of joint space width after medial opening-wedge high tibial osteotomy. Arch Orthop Trauma Surg 2022; 142:2513-2524. [PMID: 33786646 DOI: 10.1007/s00402-021-03876-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the changes in joint space width (JSW) over time after medial opening-wedge high tibial osteotomy (MOWHTO) and identify risk factors for deterioration of JSW using anteroposterior (AP) and Rosenberg views. METHODS We retrospectively analyzed changes in JSW of 104 MOWHTO patients whose preoperative osteoarthritis (OA) grade was K-L grade 3 or less on AP and Rosenberg views. Serial changes in JSW were assessed from preoperatively to at least 3 years postoperatively. Patients were divided into two groups according to JSW change patterns on each of AP and Rosenberg views: non-deterioration group had either unchanged or increased JSW, and deterioration group had decreased JSW. Clinical outcomes were compared using Western Ontario and McMaster Universities OA Index (WOMAC) score between groups. Multivariate logistic regression analysis was performed to identify risk factors for deterioration of JSW. RESULTS JSW on average for all patients increased 0.5 mm and 0.8 mm on AP and Rosenberg views, respectively (p < 0.05). Non-deterioration group showed significant improvement based on patient-reported outcomes (WOMAC) than deterioration group (all p < 0.05). Undercorrection was an independent risk factor for failure to achieve maintained or increased JSW on both AP (OR 6.885, 95% CI 1.976-23.986, p = 0.002) and Rosenberg (OR 12.756, 95% CI 2.952-55.129, p = 0.001) views. CONCLUSION JSW increased gradually and continuously on standing AP and Rosenberg views until postoperative 3 years after MOWHTO. Deterioration of JSW following MOWHTO was closely related to the undercorrection and affected clinical outcomes. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Bo Seoung Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Mortensen JF, Kappel A, Rasmussen LE, Østgaard SE, Odgaard A. The Rosenberg view and coronal stress radiographs give similar measurements of articular cartilage height in knees with osteoarthritis. Arch Orthop Trauma Surg 2022; 142:2349-2360. [PMID: 34477925 DOI: 10.1007/s00402-021-04136-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Choosing the optimal radiographic methods to diagnose the cartilage height and degree of knee osteoarthritis is crucial to determine suitability for unicompartmental knee replacement. This study aims to evaluate and compare articular cartilage thickness measured using the Rosenberg view and coronal stress radiography. Intra- and interrater agreement and test-retest reliability of each method were determined. The hypothesis of the study was that the Rosenberg view and coronal stress radiographs provide similar assessments of articular cartilage height in the medial and lateral knee compartments of osteoarthritic knees. METHODS A prospective diagnostic study, including 73 patients was performed. Inclusion criteria were enrollment for either a medial unicompartmental or a total knee replacement. Radiographs were taken as the Rosenberg view, and coronal stress radiography using the Telos stress device. Repeated measurements were performed. Experienced knee surgeons performed measurements of cartilage height at a standardized location of joint space width (JSW), and a rater-perceived location of minimal joint space width (mJSW), thus allowing for reliability and agreement analysesusing weighted kappa. Coronal stress measurements were ultimately compared to the Rosenberg view using Spearman's rank correlation. RESULTS A total of 12,264 measurements were performed. The radiographic methods proved substantial reliability. Intra- and interrater agreement showed substantial to almost perfect agreement. A very strong correlation was observed in the medial knee compartment (r = 0.91; CI = 0.84-0.95; p < 0.001), with a mean difference of 0.1 mm and limits of agreement of - 1.5 to 1.7 mm, when comparing JSW between the Rosenberg view and varus stress. Only a strong correlation was observed medially when using mJSW, and when using this measurementmore incidences of bone-on-bone were observed than when measuring with JSW. A Strong correlation was observed in the lateral knee compartment (r = 0.83; CI = 0.71-0.89; p < 0.001), with a mean difference of 0.62 mm and limits of agreement of - 1.5 to 2.7 mm, when comparing JSW between the Rosenberg view and valgus stress. CONCLUSION The Rosenberg view is similar to 20° coronal valgus-varus stress radiography for determining articular cartilage thickness. Both techniques can be used in a clinical setting. Therefore, extra radiographs, equipment and expertise could be saved, when solely utilizing the Rosenberg view which is simple to perform. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jacob F Mortensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark.
| | - Andreas Kappel
- Department of Orthopaedic Surgery, Aalborg Universitetshospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Lasse E Rasmussen
- Department of Orthopaedic Surgery, Vejle Hospital, Kabbeltoft 25, 7100, Vejle, Denmark
| | - Svend E Østgaard
- Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet, Blegdamsvej 9, 2100, København Ø, Denmark
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Jalan D, Gupta A, Khera P, Saxena S, Maley D, Elhence A. Correlation of tibiofemoral joint-space width with the clinico-radiological scoring of knee osteoarthritis – a comparison between anteroposterior and lyon-schuss radiographic views. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221080561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The degree of joint space narrowing measured on radiographs provide a reliable estimate of the extent and severity of Osteoarthritis (OA) of the knee. While the standing antero-posterior (AP) view radiographs have been used traditionally, recent studies suggest that the Lyon-Schuss (LS) view is able to detect early OA changes better. The present study was, therefore, conducted to make an objective comparison between the two views with respect to their corelation with the patient's clinical and radiological scores. Methods Forty patients (80 knees) were included in this cross-sectional study. Medial as well as lateral tibiofemoral joint space widths (JSW) were measured using vernier callipers on printed, calibrated radiographic images. Knee Society Score (Function) (KSS-F) was used as the clinical outcome measure while Ahlbäck grade was used for determining radiological severity. JSW was correlated with KSS-F and the Ahlbäck grade using Spearman's rho correlation coefficient. Reproducibility of the method was assessed using the intra-class correlation coefficient (ICC). Results Average age of the participants was 60 ± 7.65 (range 50–78) years, with 18 males and 22 females. ICC for intraobserver reliability was 0.97 and for inter-observer reliability, was 0.91 (AP view) and 0.92 (LS view), respectively. Medial JSW measurements taken on the AP view were found to have a significantly higher degree of correlation with both KSS-F and Ahlbäck grade ( p < 0.05) than those obtained from the LS view. Conclusion Although the LS view may be more sensitive for detecting early OA changes in knee, particularly in the lateral tibiofemoral compartment, the present study shows that AP view correlates better with the patient's overall clinical and radiological profile.
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Affiliation(s)
- Divesh Jalan
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Akshat Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Pushpinder Khera
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Suvinay Saxena
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Deepak Maley
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Abhay Elhence
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Wong KC, Lee M, Liow L, Lo NN, Yeo SJ, Chen J. Bone-on-Bone Contact on Radiograph is not a Prerequisite for Successful Outcome in Fixed-Bearing Medial Unicompartmental Knee Arthroplasty-A 10-Year Follow-Up Study. J Knee Surg 2021; 36:658-666. [PMID: 34952551 DOI: 10.1055/s-0041-1740932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients without bone-on-bone osteoarthritis are excluded from mobile-bearing unicompartmental knee arthroplasty due to higher revision rates and poorer outcomes. However, we do not know if the same indication applies to fixed-bearing unicompartmental knee arthroplasty implants. Our study aims to compare functional outcomes and revision rates in patients with and without bone-on-bone arthritis undergoing fixed-bearing medial unicompartmental knee arthroplasty. MATERIALS AND METHODS We reviewed 153 fixed-bearing medial unicompartmental knee arthroplasties in a single institution. Patients were divided into four groups based on joint space remaining measured on preoperative radiographs. Group 1 included knees with bone-on-bone contact; group 2 included knees with less than 2 mm joint space; group 3 included knees with 2 to 4 mm joint space; group 4 included knees with more than 4 mm joint space. Patients were followed up for 10 years postoperatively and assessed using the Oxford Knee Score, the Functional Score and Knee Score from the Knee Society Clinical Rating Score, and the Short Form 36 Health Survey. RESULTS There was no difference in terms of demographic data and preoperative scores. Postoperative Knee Society Functional Score was found to be lower in group 1 as compared with the other groups. There was no difference between the four groups of patients in terms of Knee Society Knee Score, Oxford Knee Score, and Physical Component Summary and Mental Component Summary Scores from the Short Form 36 Health Survey. There was no difference in terms of survivorship free from all-cause revision at a minimum of 10 years' follow-up. CONCLUSION Symptomatic patients with varying degrees of arthritis on preoperative radiographs had comparable clinical outcomes. We conclude that symptomatic patients with clinical and radiographic evidence of medial compartment osteoarthritis of any grade can benefit from a fixed-bearing medial unicompartmental knee arthroplasty.
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Affiliation(s)
- Khai Cheong Wong
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Merrill Lee
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Lincoln Liow
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Ngai-Nung Lo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Jerry Chen
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
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11
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Fujimura K, Haraguchi A, Sakurai R, Kamura S, Sakuraba K, Miyahara H, Fukushi JI. Have the Radiographic Characteristics of Total Knee Arthroplasty Recipients in Rheumatoid Arthritis Changed After the Induction of Biologic Disease Modifying Anti-Rheumatic Drugs? Mod Rheumatol 2021; 32:1047-1053. [PMID: 34850099 DOI: 10.1093/mr/roab114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/14/2021] [Accepted: 11/23/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Whether the characteristics of patients with rheumatoid arthritis (RA) undergoing total knee arthroplasty (TKA) have changed in the era of biologic disease-modifying antirheumatic drugs (bDMARDs) is unclear. We compared the radiographic findings of the knees in TKA recipients with RA before and after the introduction of bDMARDs. METHODS Consecutive patients who underwent primary TKA between 1999 and 2002 (115 knees; 79 patients, group A) and between 2013 and 2017 (117 knees; 95 patients, group B) were retrospectively evaluated. Clinical data, including disease duration, medication, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF), were collected. The Larsen classification, joint space narrowing (JSN), bone erosion, geode and osteophyte formation were evaluated on preoperative radiographs. RESULTS Osteophyte formation was significantly increased, and bone erosion and geode formation were significantly decreased in group B. In addition, medial-dominant JSN was significantly increased, and bicompartmental JSN was significantly decreased in group B. Medial-dominant JSN was positively, and bone erosion was negatively associated with osteophyte formation. CONCLUSIONS Following the introduction of bDMARDs, typical radiographic findings of rheumatoid knees have decreased, and secondary osteoarthritis (OA)-like changes, characterized by osteophyte formation and medial-dominant JSN, have increased in the knees of TKA recipients.
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Affiliation(s)
- Kenjiro Fujimura
- Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Akihisa Haraguchi
- Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ryuta Sakurai
- Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Satoshi Kamura
- Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Koji Sakuraba
- Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hisaaki Miyahara
- Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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12
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Jansen MP, Welsing PMJ, Vincken KL, Mastbergen SC. Performance of knee image digital analysis of radiographs of patients with end-stage knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:1530-1539. [PMID: 34343678 DOI: 10.1016/j.joca.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/10/2021] [Accepted: 07/24/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee Image Digital Analysis (KIDA) is standardized radiographic analysis software for measuring osteoarthritis (OA) characteristics. It was validated in mild OA, but used for severe OA as well. The current goal was to evaluate the performance of KIDA in severe OA. DESIGN Of 103 patients, standardized radiographs were performed before and one and 2 years after treatment for severe OA. All radiographs were evaluated on subchondral bone density, joint space width (JSW), osteophytes, eminence height, and joint angle, twice within years by the same observer. Part of the radiographs were randomly selected for reevaluation twice within 1 month and evaluation by another observer. The intraclass correlation coefficient (ICC), smallest detectable difference (SDD) and coefficient of variation (CV) were calculated; the SDD and CV were compared to those in mild OA. The relation of severity with KIDA parameters and with observer differences was calculated with linear regression. RESULTS Intra-observer ICCs were higher in the 98 severe radiographs reanalyzed within 1 month (all >0.8) than the 293 reanalyzed within years (all >0.5; most >0.8) and than inter-observer ICCs (all >0.7). SDDs and CVs were smaller when reanalyzed within a month and comparable to those in mild OA. Some parameters showed bias between readings. Severity showed significant relation with osteophytes and JSW parameters, and with the observer variation in these parameters (all P < 0.04). CONCLUSIONS KIDA is a well-performing tool also for severe OA. In order to decrease variability and SDDs, images should be analyzed in a limited time frame and randomized order.
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Affiliation(s)
- M P Jansen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - P M J Welsing
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - K L Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - S C Mastbergen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Chan EF, Cockman MD, Goel P, Newman PS, Hipp JA. Characterization of the mid-coronal plane method for measurement of radiographic change in knee joint space width across different levels of image parallax. Osteoarthritis Cartilage 2021; 29:1306-1313. [PMID: 34171474 DOI: 10.1016/j.joca.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Radiographic measurement of the change in knee joint space width (ΔJSW) is often affected by image parallax, which causes an apparent exaggeration of JSW due to projectional differences. This issue with parallax (quantified by intermargin distance) can in part be addressed with a novel mid-coronal plane (MCP) measurement method. The objectives of the study were to determine 1) accuracy and 2) reproducibility of the MCP method, and 3) compare the MCP method to that used in the Osteoarthritis Initiative (OAI) for different categories of parallax. METHODS Posteroanterior radiographs (n = 70) with known JSW were digitally reconstructed from CT images of cadaver knees and used to determine the accuracy of ΔJSW using the MCP method for parallax categories of None, Mild/Moderate, and Severe. Reproducibility was determined from pairs of clinical radiographs selected from the OAI (n = 170). The MCP method was also compared to the OAI methodology. Both reproducibility and agreement were characterized by Bland-Altman analysis and intraclass correlation coefficients (ICC). RESULTS The MCP method was accurate to 0.11 mm in cases with no parallax, and 0.18 mm across all categories of parallax for medial and lateral compartments. Reproducibility of the MCP method was graded "excellent" (ICC 0.98, 95% CI [0.98, 0.99]). The MCP results agreed very well with the OAI (ICC 0.92, 95% CI [0.89, 0.94]), with mean absolute differences between methods increasing with increasing parallax. CONCLUSION The MCP method is an accurate, reproducible alternative to the OAI method for multi-center clinical trials where subject and X-ray beam positioning may be variable.
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Affiliation(s)
- E F Chan
- Medical Metrics, Inc., 2121 Sage Road, Suite 300, Houston, TX, 77056, USA.
| | - M D Cockman
- Medical Metrics, Inc., 2121 Sage Road, Suite 300, Houston, TX, 77056, USA.
| | - P Goel
- Medical Metrics, Inc., 2121 Sage Road, Suite 300, Houston, TX, 77056, USA.
| | - P S Newman
- Medical Metrics, Inc., 2121 Sage Road, Suite 300, Houston, TX, 77056, USA.
| | - J A Hipp
- Medical Metrics, Inc., 2121 Sage Road, Suite 300, Houston, TX, 77056, USA.
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14
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Jansen MP, Mastbergen SC, Eckstein F, van Heerwaarden RJ, Spruijt S, Lafeber FPJG. Comparison between 2D radiographic weight-bearing joint space width and 3D MRI non-weight-bearing cartilage thickness measures in the knee using non-weight-bearing 2D and 3D CT as an intermediary. Ther Adv Chronic Dis 2021; 12:20406223211037868. [PMID: 34434539 PMCID: PMC8381425 DOI: 10.1177/20406223211037868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: In knee osteoarthritis, radiographic joint space width (JSW) is frequently
used as a surrogate marker for cartilage thickness; however, longitudinal
changes in radiographic JSW have shown poor correlations with those of
magnetic resonance imaging (MRI) cartilage thickness. There are fundamental
differences between the techniques: radiographic JSW represents
two-dimensional (2D), weight-bearing, bone-to-bone distance, while on MRI
three-dimensional (3D) non-weight-bearing cartilage thickness is measured.
In this exploratory study, computed tomography (CT) was included as a third
technique, as it can measure bone-to-bone under non-weight-bearing
conditions. The objective was to use CT to compare the impact of
weight-bearing versus non-weight-bearing, as well as
bone-to-bone JSW versus actual cartilage thickness, in the
knee. Methods: Osteoarthritis patients (n = 20) who were treated with knee
joint distraction were included. Weight-bearing radiographs,
non-weight-bearing MRIs and CTs were acquired before and 2 years after
treatment. The mean radiographic JSW and cartilage thickness of the most
affected compartment were measured. From CT, the 3D median JSW was
calculated and a 2D projectional image was rendered, positioned similarly
and measured identically to the radiograph. Pearson correlations between the
techniques were derived, both cross-sectionally and longitudinally. Results: Fourteen patients could be analyzed. Cross-sectionally, all comparisons
showed moderate to strong significant correlations (R = 0.43–0.81; all
p < 0.05). Longitudinal changes over time were
small; only the correlations between 2D CT and 3D CT (R = 0.65;
p = 0.01) and 3D CT and MRI (R = 0.62;
p = 0.02) were statistically significant. Conclusion: The poor correlation between changes in radiographic JSW and MRI cartilage
thickness appears primarily to result from the difference in weight-bearing,
and less so from measuring bone-to-bone distance versus
cartilage thickness.
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Affiliation(s)
- Mylène P Jansen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100 (G02.228), Utrecht 3584CX, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Felix Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
| | - Ronald J van Heerwaarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Sander Spruijt
- Reinier Haga Orthopaedic Centre, Zoetermeer, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Bany Muhammad M, Yeasin M. Interpretable and parameter optimized ensemble model for knee osteoarthritis assessment using radiographs. Sci Rep 2021; 11:14348. [PMID: 34253839 PMCID: PMC8275586 DOI: 10.1038/s41598-021-93851-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 06/28/2021] [Indexed: 11/09/2022] Open
Abstract
Knee osteoarthritis (KOA) is an orthopedic disorder with a substantial impact on mobility and quality of life. An accurate assessment of the KOA levels is imperative in prioritizing meaningful patient care. Quantifying osteoarthritis features such as osteophytes and joint space narrowing (JSN) from low-resolution images (i.e., X-ray images) are mostly subjective. We implement an objective assessment and quantification of KOA to aid practitioners. In particular, we developed an interpretable ensemble of convolutional neural network (CNN) models consisting of three modules. First, we developed a scale-invariant and aspect ratio preserving model to localize Knee joints. Second, we created multiple instances of "hyperparameter optimized" CNN models with diversity and build an ensemble scoring system to assess the severity of KOA according to the Kellgren-Lawrence grading (KL) scale. Third, we provided visual explanations of the predictions by the ensemble model. We tested our models using a collection of 37,996 Knee joints from the Osteoarthritis Initiative (OAI) dataset. Our results show a superior (13-27%) performance improvement compared to the state-of-the-art methods.
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Affiliation(s)
- Mohammed Bany Muhammad
- Department of Electrical and Computer Engineering, Herff College, University of Memphis, Memphis, TN, USA.
| | - Mohammed Yeasin
- Department of Electrical and Computer Engineering, Herff College, University of Memphis, Memphis, TN, USA
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16
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Khury F, Fuchs M, Awan Malik H, Leiprecht J, Reichel H, Faschingbauer M. Validation of joint space narrowing on plain radiographs and its relevance to partial knee arthroplasty. Bone Joint Res 2021; 10:173-187. [PMID: 33685206 PMCID: PMC7998068 DOI: 10.1302/2046-3758.103.bjr-2020-0216.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS To explore the clinical relevance of joint space width (JSW) narrowing on standardized-flexion (SF) radiographs in the assessment of cartilage degeneration in specific subregions seen on MRI sequences in knee osteoarthritis (OA) with neutral, valgus, and varus alignments, and potential planning of partial knee arthroplasty. METHODS We retrospectively reviewed 639 subjects, aged 45 to 79 years, in the Osteoarthritis Initiative (OAI) study, who had symptomatic knees with Kellgren and Lawrence grade 2 to 4. Knees were categorized as neutral, valgus, and varus knees by measuring hip-knee-angles on hip-knee-ankle radiographs. Femorotibial JSW was measured on posteroanterior SF radiographs using a special software. The femorotibial compartment was divided into 16 subregions, and MR-tomographic measurements of cartilage volume, thickness, and subchondral bone area were documented. Linear regression with adjustment for age, sex, body mass index, and Kellgren and Lawrence grade was used. RESULTS We studied 345 neutral, 87 valgus, and 207 varus knees. Radiological JSW narrowing was significantly (p < 0.01) associated with cartilage volume and thickness in medial femorotibial compartment in neutral (r = 0.78, odds ratio (OR) 2.33) and varus knees (r = 0.86, OR 1.92), and in lateral tibial subregions in valgus knees (r = 0.87, OR 3.71). A significant negative correlation was found between JSW narrowing and area of subchondral bone in external lateral tibial subregion in valgus knees (r = -0.65, p < 0.01) and in external medial tibial subregion in varus knees (r = -0.77, p < 0.01). No statistically significant correlation was found in anterior and posterior subregions. CONCLUSION SF radiographs can be potentially used for initial detection of cartilage degeneration as assessed by MRI in medial and lateral but not in anterior or posterior subregions. Cite this article: Bone Joint Res 2021;10(3):173-187.
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Affiliation(s)
- Farouk Khury
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany.,Division of Orthopedic Surgery, Rambam Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Michael Fuchs
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | | | - Janina Leiprecht
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
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Badar F, Lee J, Qu X, Xia Y. Topographical and zonal patterns of T2 relaxation in osteoarthritic tibial cartilage by low- and high-resolution MRI. Magn Reson Imaging 2021; 78:98-108. [PMID: 33493580 DOI: 10.1016/j.mri.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/20/2020] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to establish the topographical and zonal T2 patterns of multi-resolution MRI in medial tibial cartilage in a canine model of osteoarthritis (OA), initiated by the anterior cruciate ligament (ACL) transection surgery, and studied after 8-weeks and 12-weeks post-surgery. METHODS Articular cartilage from healthy, two stages of contralateral, and of OA knees were quantitatively imaged by the MRI T2 protocols at two imaging resolutions (100 and 17.6 μm/pixel). The zonal T2 changes at five topographical locations (anterior (AMT), exterior (EMT), posterior (PMT), central (CMT) and interior (IMT) medial tibia) and subsequent two averaged regions (covered by meniscus and exposed) were analyzed. At each location, full-thickness cartilage was studied in four sub-tissue zones (superficial, transitional, upper and lower radial zones). RESULTS Tissue degradation can be detected by measurable changes of T2, which is resolution- and orientation-dependent. T2 changes ranging from +28.82% increase (SZ, PMT) to -23.15% decrease (RZ1, AMT) in healthy to disease (8C), with the largest increase of T2 in the surface tissue. Various location-dependent patterns of degradation are found over the tibial surface, most commonly shown in early-stage OA (8C) on the anterior site, different from the posterior. Finally, the contralateral cartilage has specific degradation patterns, different from those in OA cartilage. CONCLUSIONS This is the first quantitative and highest multi-resolution characterization of cartilage at five topographical locations over the medial tibial plateau with fine zonal resolution in an animal model of OA, which would benefit future investigation of human OA in clinics.
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Affiliation(s)
- Farid Badar
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA
| | - Jihyun Lee
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA
| | - Xianggui Qu
- Department of Mathematics and Statistics, Oakland University, Rochester, MI 48309, USA
| | - Yang Xia
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI 48309, USA.
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Muñoz-García N, Cordero-Ampuero J, Madero-Jarabo R. Diagnostic Accuracy of Magnetic Resonance Images and Weight-Bearing Radiographs in Patients With Arthroscopic-Proven Medial Osteoarthritis of the Knee. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2020; 13:1179544120938369. [PMID: 32843843 PMCID: PMC7418247 DOI: 10.1177/1179544120938369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 01/07/2023]
Abstract
Aims: The aim of this study is to analyze the diagnostic value of weight-bearing radiographs, magnetic resonance images (MRI), and the combination of both in osteoarthritic knees when using arthroscopic findings as the “gold standard” to compare with. Methods: A total of 59 patients were studied because of chronic pain in 1 of their knees. Radiographs were classified according to Kellgren-Lawrence scale. Magnetic resonance images were classified according to Vallotton, and arthroscopic findings according to Outerbridge criteria. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 75.0%, 60.0%, 56.2%, 77.8%, and 66.1% for weight-bearing radiographs, and 70.8%, 88.6%, 81.0%, 81.6%, and 81.4% for MRI. Logistic regression analysis showed that a weight-bearing radiograph added to MRI offered no additional diagnostic value compared with MRI alone (P < .001). Conclusions: Magnetic resonance images presented higher specificity, positive and negative predictive values, and accuracy than weight-bearing radiographs for knee osteoarthritis. The combination of radiographs and MRI did not improve the diagnostic accuracy, compared with MRI alone.
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Affiliation(s)
- Nuria Muñoz-García
- Department of Orthopaedic Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - José Cordero-Ampuero
- Department of Orthopaedic Surgery, La Princesa University Hospital, Autonoma University, Madrid, Spain
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Conrozier T, Eymard F, Chouk M, Chevalier X. Impact of obesity, structural severity and their combination on the efficacy of viscosupplementation in patients with knee osteoarthritis. BMC Musculoskelet Disord 2019; 20:376. [PMID: 31421686 PMCID: PMC6698328 DOI: 10.1186/s12891-019-2748-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/31/2019] [Indexed: 01/15/2023] Open
Abstract
Background Obesity and radiological severity have been identified to be independent predictors of a low rate of response to viscosupplementation (VS), in patients with knee osteoarthritis (OA). Is that enough to formally refute VS in such patients in whom surgery is sometimes contraindicated? Objectives To compare pain and function scores before and 6 months after knee VS, according to the weight status (obese versus non obese), the radiological severity (mild/moderate versus severe) and both combined. Methods Post-hoc analysis of a prospective, double blind, randomized, multicentre trial, comparing 2 viscosupplements, in patients with symptomatic knee OA. Patients were classified according to body mass index (BMI < or ≥ 30 kg.− 2), OARSI radiological grade (1–2 versus 3) and OMERACT-OARSI response criteria (Yes/No). WOMAC between-group comparisons (obese versus non-obese, OARSI 1–2 versus 3, and both combined) in all patients and in OMERACT-OARSI Responders, were achieved using Mannn-Whitney U test. Results One-hundred and sixty-six patients were analyzed: 28.3% were obese, 44% were OARSI grade 3, 42,2% were neither obese nor OARSI 3, whereas 14.5% were obese and OARSI 3. At baseline WOMAC pain score did not differ according to the patients sub-groups (p > 0.05). Six months after VS, WOMAC pain decreased significantly in all patient sub-groups (all p < 0.01). At month 6, WOMAC pain sub-score was significantly lower in non-obese than in obese patients (4.9 ± 4.1 versus 7.1 ± 4.9; p = 0.008) and in patients OARSI 1–2 versus 3 (4.8 ± 4.3 versus 6.4 ± 4.5; p = 0.009). However, in responder patients there was no difference in pain score and pain decrease related to the weight status and the radiological score. Conclusion These results do not confirm our previous conclusions that recommended not performing VS in obese patients with severe knee OA. Although the chances of being a responder were much reduced in these patients, the benefit of patients who respond to treatment was similar to that of subjects with normal weight and mild/moderate OA. Different pain phenotypes, more than overweight and advanced disease, might be the main reason for the success or failure of VS.
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Affiliation(s)
- Thierry Conrozier
- Department of rheumatology, Hôpital Nord Franche-Comté, 100 route de Moval, CS 10490, Trevenans, 90015, Belfort, France.
| | - Florent Eymard
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France
| | - Mickael Chouk
- Department of rheumatology, Hôpital Nord Franche-Comté, 100 route de Moval, CS 10490, Trevenans, 90015, Belfort, France
| | - Xavier Chevalier
- Department of Rheumatology, Hôpital Henri Mondor, Creteil, France
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Missing Data in Marginal Structural Models: A Plasmode Simulation Study Comparing Multiple Imputation and Inverse Probability Weighting. Med Care 2019; 57:237-243. [PMID: 30664611 DOI: 10.1097/mlr.0000000000001063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The use of marginal structural models (MSMs) to adjust for time-varying confounding has increased in epidemiologic studies. However, in the setting of MSMs, recommendations for how best to handle missing data are contradictory. We present a plasmode simulation study to compare the validity and precision of MSMs estimates using complete case analysis (CC), multiple imputation (MI), and inverse probability weighting (IPW) in the presence of missing data on time-independent and time-varying confounders. MATERIALS AND METHODS Simulations were based on a cohort substudy using data from the Osteoarthritis Initiative which estimated the marginal causal effect of intra-articular injection use on yearly changes in knee pain. We simulated 81 scenarios with parameter values varied on missing mechanisms (MCAR, MAR, and MNAR), percentages of missing (10%, 20%, and 30%), type of confounders (time-independent, time-varying, either or both), and analytical approaches (CC, IPW, and MI). The performance of CC, IPW, and MI methods was compared using relative bias, mean squared error of the estimates of interest, and empirical power. RESULTS Across scenarios defined by missing data mechanism, extent of missing data, and confounder type, MI generally produced less biased estimates (range: 1.2%-6.7%) with better precision (range: 0.17-0.18) compared with IPW (relative bias: -5.3% to 8.0%; precision: 0.19-0.53). Empirical power was constant across the scenarios using MI. CONCLUSIONS Under simple yet realistically constructed scenarios, MI seems to confer an advantage over IPW in MSMs applications.
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21
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Liu SH, Dubé CE, Eaton CB, Driban JB, McAlindon TE, Lapane KL. Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis. J Rheumatol 2018; 45:1316-1324. [PMID: 29907665 DOI: 10.3899/jrheum.171385] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We examined the longterm effectiveness of corticosteroid or hyaluronic acid injections in relieving symptoms among persons with knee osteoarthritis (OA). METHODS Using Osteoarthritis Initiative data, a new-user design was applied to identify participants initiating corticosteroid or hyaluronic acid injections (n = 412). Knee symptoms (pain, stiffness, function) were measured using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used marginal structural models adjusting for time-varying confounders to estimate the effect on symptoms of newly initiated injection use compared to nonusers over 2 years of followup. RESULTS Among 412 participants initiating injections, 77.2% used corticosteroid injections and 22.8% used hyaluronic acid injections. About 18.9% had additional injection use after initiation, but switching between injection types was common. Compared to nonusers, on average, participants initiating a corticosteroid injection experienced a worsening of pain (yearly worsening: 1.24 points, 95% CI 0.82-1.66), stiffness (yearly worsening: 0.30 points, 95% CI 0.10-0.49), and physical functioning (yearly worsening: 2.62 points, 95% CI 0.94-4.29) after adjusting for potential confounders with marginal structural models. Participants initiating hyaluronic acid injections did not show improvements of WOMAC subscales (pain: 0.50, 95% CI -0.11 to 1.11; stiffness: -0.07, 95% CI -0.38 to 0.24; and functioning: 0.49, 95% CI -1.34 to 2.32). CONCLUSION Although intraarticular injections may support the effectiveness of reducing symptoms in short-term clinical trials, the initiation of corticosteroid or hyaluronic acid injections did not appear to provide sustained symptom relief over 2 years of followup for persons with knee OA.
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Affiliation(s)
- Shao-Hsien Liu
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA. .,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School.
| | - Catherine E Dubé
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Charles B Eaton
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Jeffrey B Driban
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Timothy E McAlindon
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Kate L Lapane
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
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Kan H, Arai Y, Kobayashi M, Nakagawa S, Inoue H, Hino M, Komaki S, Ikoma K, Ueshima K, Fujiwara H, Yokota I, Kubo T. Fixed-flexion view X-ray of the knee superior in detection and follow-up of knee osteoarthritis. Medicine (Baltimore) 2017; 96:e9126. [PMID: 29245351 PMCID: PMC5728966 DOI: 10.1097/md.0000000000009126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A fixed flexion view (FFV) is useful for evaluating joint space when assessing the severity of osteoarthritis (OA) of the knee. We analyzed changes in joint space revealed by standing extended view (SEV) and FFV over a mean 4 years, to compare both views on their capacity to measure joint space width accurately at particular time points during follow-up.SEV and FFV images were acquired in patients with knee OA. The 81 patients (157 knees) followed up for ≥24 months were selected as study subjects. Medial joint space widths (MJSW), Kellgren-Lawrence (KL) grades, and reductions in MJSW on SEV (ΔSEV) and FFV (ΔFFV) were compared in knees evaluated by SEV and FFV.At both time-points, mean MJSW was significantly lower by FFV than by SEV. Mean MJSW was significantly lower at follow-up than at first examination by both SEV and FFV. At both time-points, the KL grade was higher by FFV than by SEV group. The ΔFFV was significantly greater than the ΔSEV. ΔSEV did not differ significantly among KL grades, but ΔFFV was significantly greater in patients with KL grade II than in patients with other KL grades.FFV is not only useful for evaluating joint space in knees with OA, but also for accurately evaluating the progression of OA. The risk of rapid progression of knee OA may be higher in patients with KL grade II, as determined by FFV. FFV may be superior to SEV in determining appropriate treatment strategies for knee OA.
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Affiliation(s)
- Hiroyuki Kan
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
- Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | | | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Manabu Hino
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
- Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine
| | - Shintaro Komaki
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
- Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Keiichiro Ueshima
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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23
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Snekhalatha U, Rajalakshmi T, Gopikrishnan M, Gupta N. Computer-based automated analysis of X-ray and thermal imaging of knee region in evaluation of rheumatoid arthritis. Proc Inst Mech Eng H 2017; 231:1178-1187. [PMID: 29076764 DOI: 10.1177/0954411917737329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim and objectives of the study are as follows: (1) to perform automated segmentation of knee X-ray images using fast greedy snake algorithm and feature extraction using gray level co-occurrence matrix method, (2) to implement automated segmentation of knee thermal image using RGB segmentation method and (3) to compare the features extracted from the segmented knee region of X-ray and thermal images in rheumatoid arthritis patients using a biochemical method as standard. In all, 30 rheumatoid arthritis patients and 30 age- and sex-matched healthy volunteers were included in the study. X-ray and thermography images of knee regions were acquired, and biochemical tests were carried out subsequently. The X-ray images were segmented using fast greedy snake algorithm, and feature extractions were performed using gray level co-occurrence matrix method. The thermal image was segmented using RGB-based segmentation method and statistical features were extracted. Statistical features extracted after segmentation from X-ray and thermal imaging of knee region were correlated with the standard biochemical parameters. The erythrocyte sedimentation rate shows statistically significant correlations (p < 0.01) with the X-ray parameters such as joint space width and % combined cortical thickness. The skin surface temperature measured from knee region of thermal imaging was highly correlated with erythrocyte sedimentation rate. Among all the extracted features namely mean, variance, energy, homogeneity and difference entropy depict statistically significant percentage differences between the rheumatoid arthritis and healthy subjects. From this study, it was observed that thermal infrared imaging technique serves as a potential tool in the evaluation of rheumatoid arthritis at an earlier stage compared to radiography. Hence, it was predicted that thermal imaging method has a competency in the diagnosis of rheumatoid arthritis by automated segmentation methods.
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Affiliation(s)
- U Snekhalatha
- 1 Department of Biomedical Engineering, Faculty of Engineering and Technology, SRM University, Chennai, India
| | - T Rajalakshmi
- 1 Department of Biomedical Engineering, Faculty of Engineering and Technology, SRM University, Chennai, India
| | - M Gopikrishnan
- 1 Department of Biomedical Engineering, Faculty of Engineering and Technology, SRM University, Chennai, India
| | - Nilkantha Gupta
- 2 Center for Environmental Nuclear Research, SRM University, Chennai, India
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24
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Liu SH, Dubé CE, Driban JB, McAlindon TE, Eaton CB, Lapane KL. Patterns of intra-articular injection use after initiation of treatment in patients with knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage 2017; 25:1607-1614. [PMID: 28627466 PMCID: PMC5605414 DOI: 10.1016/j.joca.2017.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We sought to describe and evaluate longitudinal use of intra-articular injections after treatment initiation among adults with radiographically confirmed knee osteoarthritis (OA). METHOD Using data from the Osteoarthritis Initiative (OAI), we included participants with radiographically confirmed OA (Kellgren-Lawrence grade (K-L) ≥ 2) in ≥1 knee at baseline. With 9 years of data, 412 participants newly initiating hyaluronic acid or corticosteroid injections with their index visit were identified. For each type of injection initiated, socio-demographic and clinical characteristics were described by patterns of treatments (one-time use, switched, or continued injections). Multinomial logistic models estimated the extent to which patient-reported symptoms (post-initial injection and changes over time) were associated with patterns of injection use. RESULTS Of those initiating injections, ∼19% switched, ∼21% continued injection type, and ∼60% did not report any additional injections. For participants initiating corticosteroid injections, greater symptoms post-initial injection were associated with lower odds of continued use compared to one-time users (adjusted odds ratio (aOR) for Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain: 0.91; 95%, confidence interval (CI): 0.83 to 0.99; aORstiffness: 0.77; CI: 0.63 to 0.94; aORphysical function: 0.97; CI: 0.94 to 1.00). Symptom changes over time (e.g., worsened or improved) were not associated with patterns of injections use. CONCLUSION After treatment initiation, the proportion of patients switching injection use and one-time users was substantial. Symptoms post-initial injection appear to be associated with patterns of injection use. The extent to which these patterns are an indication of lack of impact on patient-reported symptoms should be explored.
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Affiliation(s)
- S-H Liu
- Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
| | - C E Dubé
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA.
| | - J B Driban
- Division of Rheumatology, Tufts Medical Center, Boston, MA, 02111, USA.
| | - T E McAlindon
- Division of Rheumatology, Tufts Medical Center, Boston, MA, 02111, USA.
| | - C B Eaton
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI, 02860, USA; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School, School of Public Health, Brown University, Providence, RI, 02912, USA.
| | - K L Lapane
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01605, USA.
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25
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Mehta N, Duryea J, Badger GJ, Akelman MR, Jones MH, Spindler KP, Fleming BC. Comparison of 2 Radiographic Techniques for Measurement of Tibiofemoral Joint Space Width. Orthop J Sports Med 2017; 5:2325967117728675. [PMID: 28989937 PMCID: PMC5624356 DOI: 10.1177/2325967117728675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: No consensus is available regarding the best method for measuring tibiofemoral joint space width (JSW) on radiographs to quantify joint changes after injury. Studies that track articular cartilage thickness after injury frequently use patients’ uninjured contralateral knees as controls, although the literature supporting this comparison is limited. Purpose: (1) To compare JSW measurements using 2 established measurement techniques in healthy control participants and (2) to determine whether the mean JSW of the uninjured contralateral knee in a cohort with anterior cruciate ligament (ACL) reconstruction is different from that obtained from a true control population. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Medial and lateral JSWs were measured on standardized, bilateral, semiflexed metatarsophalangeal positioning, posteroanterior radiographs of 60 healthy individuals (26 females; mean ± SD age, 25 ± 6.2 years; no history of knee injury) via 2 published techniques: a computerized surface-delineation method (surface-fit method) and a manual digitization method (midpoint method). Bland-Altman method was used to examine the agreement between JSW measurements obtained with the 2 methods and to examine the agreement between measurements obtained on left and right knees within a participant for each measurement method. Within- and between-participant variance components and intraclass correlation coefficients (ICCs) were computed for JSW measurements corresponding to each method. Two-sample t tests were used to compare the surface-fit method measurements of mean JSW of the true control group (n = 60) with the previously published mean JSW measurements from the Multicenter Orthopaedics Outcomes Network (MOON) nested cohort of 262 contralateral uninjured knees 2 to 3 years after ACL reconstruction. Results: For JSW in the medial compartment, the surface-fit method had lower within-participant interknee variability (σ2within, 0.064; 95% CI, 0.04-0.09) compared with the midpoint method (σ2within, 0.28; 95% CI, 0.20-0.43) and a higher ICC (0.93 vs 0.65; P < .001). Lateral JSW values were similar for the surface-fit method (σ2within, 0.27; 95% CI, 0.18-0.43) and the midpoint method (σ2within, 0.20; 95% CI, 0.14-0.31), with ICCs of 0.75 and 0.77, respectively (P = .80). With the surface-fit method, mean JSW measurements of the medial and lateral compartments of a control population were not significantly different from the contralateral uninjured knees of patients after ACL reconstruction. Conclusion: For measuring medial JSW, the surface-fit method was less variable across knees within a participant than the midpoint method, as evidenced by larger ICCs and lower interknee variability. For measuring lateral JSW, the 2 methods were similar. The JSW measurements of uninjured contralateral knees of patients with ACL reconstruction at 2 to 3 years postsurgery were not significantly different from those of a cohort of healthy control participants. Future work should be performed to demonstrate the validity of these methods for documenting change over time in the ACL-reconstructed knee.
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Affiliation(s)
- Nabil Mehta
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jeffrey Duryea
- Department of Radiology, Brigham and Women's Hospital/Harvard University, Boston Massachusetts, USA
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Matthew R Akelman
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Braden C Fleming
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, Rhode Island, USA
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Sakellariou G, Conaghan PG, Zhang W, Bijlsma JWJ, Boyesen P, D'Agostino MA, Doherty M, Fodor D, Kloppenburg M, Miese F, Naredo E, Porcheret M, Iagnocco A. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis 2017; 76:1484-1494. [DOI: 10.1136/annrheumdis-2016-210815] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/25/2017] [Accepted: 03/05/2017] [Indexed: 11/04/2022]
Abstract
The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot; imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms; the role of imaging in differential diagnosis; the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs; CR as the first-choice imaging modality; consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.
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27
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Badar F, Xia Y. Image interpolation improves the zonal analysis of cartilage T2 relaxation in MRI. Quant Imaging Med Surg 2017; 7:227-237. [PMID: 28516048 DOI: 10.21037/qims.2017.03.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND This project aimed to investigate the improvement in the detection of osteoarthritis (OA) in cartilage by the interpolation of T2 images, in the situation when the native MRI resolution is insufficient to resolve the depth-dependent T2 characteristics in articular cartilage (AC). METHODS Eighteen intact canine knee joints that were healthy or had mild (contralateral) or severe OA were T2-imaged in a 7T/20 cm MRI system at 200 µm/pixel resolution (macro-MRI). Two image analysis methods were used to interpolate the images to 100 µm/pixel, i.e., by Fourier-transforming the time-domain FID (Free Induction Decay) signal using the Varian NMR software and by interpolating the 2D T2 image using the ImageJ software. RESULTS The T2 profiles from 30 individual ROI of each healthy [6], mild [6] and OA [6] cartilage at 200 µm and the interpolated 100 µm resolutions were subdivided into two equal-thickness regions and three-equal thickness regions based on clinical MRI protocols. A new method divided the T2 profiles into three-unequal thickness zones according to the T2 profiles at 17.6 µm/pixel from the same cartilage imaged in a 7 Tesla/9 cm µMRI system. Both interpolation methods improved the depth-dependent T2 images/profiles in macro-MRI. The unequal zone division in T2 had better OA sensitivity than the equal zone division. The three-equal zone division of T2 profiles had better OA sensitivity than the two-equal zone division. The statistical significant difference between the healthy and mild OA cartilage is detected (P=0.0018) only by the unequal zone division method at 100 µm resolution. CONCLUSIONS Data interpolation improves the T2 sensitivity in MRI of cartilage OA. Unequal division of tissue thickness enables better early stage of OA detection than the equal division.
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Affiliation(s)
- Farid Badar
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI, USA
| | - Yang Xia
- Department of Physics and Center for Biomedical Research, Oakland University, Rochester, MI, USA
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28
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Kan H, Arai Y, Kobayashi M, Nakagawa S, Inoue H, Hino M, Komaki S, Ikoma K, Ueshima K, Fujiwara H, Kubo T. Radiographic Measurement of Joint Space Width Using the Fixed Flexion View in 1,102 Knees of Japanese Patients with Osteoarthritis in Comparison with the Standing Extended View. Knee Surg Relat Res 2017; 29:63-68. [PMID: 28231651 PMCID: PMC5336370 DOI: 10.5792/ksrr.16.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 12/22/2022] Open
Abstract
Purpose The fixed flexion view (FFV) of the knee is considered useful for evaluating the joint space when assessing the severity of osteoarthritis (OA) of the knee. To clarify the usefulness of FFV for evaluation of the joint space and severity of knee OA, this study evaluated changes in the joint space on the FFV and standing extended view (SEV) in patients with knee OA. Materials and Methods The SEV and FFV images were acquired in 567 patients (1,102 knees) who visited the hospital with a chief complaint of knee joint pain. Medial joint space width (MJSW) and Kellgren-Lawrence (K-L) classification assessed using the SEV and FFV images were compared. Results Mean MJSW was significantly smaller when assessed on the FFV than on the SEV (3.02±1.55 mm vs. 4.31±1.30 mm; p<0.001). The K-L grade was the same or higher on the FFV than on the SEV. Conclusions The FFV is more useful than the SEV for evaluating the joint space in OA knees. Treatment strategies in patients with knee OA should be determined based on routinely acquired FFV images.
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Affiliation(s)
- Hiroyuki Kan
- Departments of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Inoue
- Departments of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Manabu Hino
- Departments of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Japan
| | - Shintaro Komaki
- Departments of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuya Ikoma
- Departments of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichiro Ueshima
- Departments of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Departments of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshikazu Kubo
- Departments of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Segal NA, Bergin J, Kern A, Findlay C, Anderson DD. Test-retest reliability of tibiofemoral joint space width measurements made using a low-dose standing CT scanner. Skeletal Radiol 2017; 46:217-222. [PMID: 27909787 PMCID: PMC5179299 DOI: 10.1007/s00256-016-2539-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/21/2016] [Accepted: 11/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the test-retest reliability of knee joint space width (JSW) measurements made using standing CT (SCT) imaging. SUBJECTS AND METHODS This prospective two-visit study included 50 knees from 30 subjects (66% female; mean ± SD age 58.2 ± 11.3 years; BMI 29.1 ± 5.6 kg/m2; 38% KL grade 0-1). Tibiofemoral geometry was obtained from bilateral, approximately 20° fixed-flexed SCT images acquired at visits 2 weeks apart. For each compartment, the total joint area was defined as the area with a JSW <10 mm. The summary measurements of interest were the percentage of the total joint area with a JSW less than 0.5-mm thresholds between 2.0 and 5.0 mm in each tibiofemoral compartment. Test-retest reliability of the summary JSW measurements was assessed by intraclass correlation coefficients (ICC 2,1) for the percentage area engaged at each threshold of JSW and root-mean-square errors (RMSE) were calculated to assess reproducibility. RESULTS The ICCs were excellent for each threshold assessed, ranging from 0.95 to 0.97 for the lateral and 0.90 to 0.97 for the medial compartment. RMSE ranged from 1.1 to 7.2% for the lateral and from 3.1 to 9.1% for the medial compartment, with better reproducibility at smaller JSW thresholds. CONCLUSION The knee joint positioning protocol used demonstrated high day-to-day reliability for SCT 3D tibiofemoral JSW summary measurements repeated 2 weeks apart. Low-dose SCT provides a great deal of information about the joint while maintaining high reliability, making it a suitable alternative to plain radiographs for evaluating JSW in people with knee OA.
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Affiliation(s)
- Neil A. Segal
- Professor, Department of Rehabilitation Medicine, The University of Kansas (Kansas City, KS)
| | | | | | | | - Donald D. Anderson
- Professor, Department of Orthopaedics and Rehabilitation, The University of Iowa (Iowa City, IA)
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Komatsu D, Hasegawa Y, Kojima T, Seki T, Higuchi Y, Ishiguro N. Absence of a relationship between joint space narrowing and osteophyte formation in early knee osteoarthritis among Japanese community-dwelling elderly individuals: A cross-sectional study. Mod Rheumatol 2016; 27:675-682. [PMID: 27739350 DOI: 10.1080/14397595.2016.1232775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Joint space narrowing and osteophyte formation, radiographic features of knee osteoarthritis (OA), are not necessarily synchronous processes. We evaluated the relationship between medial minimum joint space width (mJSW) and osteophyte formation. METHODS We conducted a retrospective study of 1050 individuals (424 males; 626 females; mean age 64.9 years) who underwent knee radiography as part of a health screening program, between 2011 and 2013. mJSW and tibial osteophyte area (OF) were quantified using automated software. The mJSW range was subdivided into tertiles, and OF, mJSW, and quality of life (QOL) were compared among them. Correlation between OF and mJSW was evaluated. RESULTS In females, OF was largest and correlated with mJSW only in the lowest tertile group. Patients in the lowest mJSW tertile group had a lower QOL and higher pain than those in the other two groups. Based on our generalized additive models and a receiver operating characteristic curve analysis, an mJSW cutoff point of 3.5 mm was apparent in females, with no significant cutoff identified in males. CONCLUSIONS OF correlates with mJSW below a cutoff value of about 3.5 mm in females. OA symptoms, namely physical function impairment and pain, increases significantly as mJSW decreases below the cutoff. .
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Affiliation(s)
| | - Yukiharu Hasegawa
- b Department of Hip and Knee Reconstructive Surgery , Nagoya University Graduate School of Medicine , Showa-ku Nagoya , Aichi , Japan
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Pinsornsak P, Naratrikun K, Kanitnate S, Sangkomkamhang T. The one-leg standing radiograph: An improved technique to evaluate the severity of knee osteoarthritis. Bone Joint Res 2016; 5:436-41. [PMID: 27683299 PMCID: PMC5047052 DOI: 10.1302/2046-3758.59.bjr-2016-0049.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The purpose of this study was to compare the joint space width between one-leg and both-legs standing radiographs in order to diagnose a primary osteoarthritis of the knee. Methods Digital radiographs of 100 medial osteoarthritic knees in 50 patients were performed. The patients had undergone one-leg standing anteroposterior (AP) views by standing on the affected leg while a both-legs standing AP view was undertaken while standing on both legs. The severity of the osteoarthritis was evaluated using the joint space width and Kellgren-Lawrence (KL) radiographic classification. The t-test was used for statistical analysis. Results The mean medial joint space width found in the one-leg and in the both-legs standing view were measured at 1.8 mm and 2.4 mm, respectively (p < 0.001, 95% CI 0.5 to 0.7). 33%, 47.4% and 23.1% of the knees diagnosed with a KL grade of I, II and III in the both-legs standing views were changed to KL grade II, III and IV in the one-leg standing views, respectively. No changes for KL IV osteoarthritis diagnoses have been found between both- and one-leg standing views. Conclusions One-leg standing radiographs better represent joint space width than both-legs standing radiographs. 32% of both-legs standing radiographs have changed the KL grading to a more severe grade than that in the one-leg standing radiographs. Cite this article: P. Pinsornsak, K. Naratrikun, S. Kanitnate, T. Sangkomkamhang. The one-leg standing radiograph: An improved technique to evaluate the severity
of knee osteoarthritis. Bone Joint Res 2016;5:436–441. DOI: 10.1302/2046-3758.59.BJR-2016-0049.R1.
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Affiliation(s)
- P Pinsornsak
- Department of Orthopaedics, Thammasat University, Pathum Thani, Thailand
| | - K Naratrikun
- Department of Orthopaedics, Thammasat University, Pathum Thani, Thailand
| | - S Kanitnate
- Department of Orthopaedics, Thammasat University, Pathum Thani, Thailand
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Chen SH, Kuan TS, Kao MJ, Wu WT, Chou LW. Clinical effectiveness in severe knee osteoarthritis after intra-articular platelet-rich plasma therapy in association with hyaluronic acid injection: three case reports. Clin Interv Aging 2016; 11:1213-1219. [PMID: 27660427 PMCID: PMC5019165 DOI: 10.2147/cia.s114795] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Osteoarthritis (OA) is a degenerative disorder resulting from loss of joint cartilage and underlying bone and causes pain and loss of function. The treatment of knee OA is still a challenge because of the poor self-regeneration capacity of cartilage. The nonsurgical interventions include control of the aggravating factor (such as weight control and the use of walking aids), symptomatic treatment (such as acetaminophen or nonsteroidal anti-inflammatory drugs), prolotherapy, and viscosupplementation. However, the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) has not been widely used because of lack of clinical evidence and several limitations in patients with severe knee OA. Three patients who suffered from knee pain and poor walking endurance were diagnosed with advanced knee OA. They underwent PRP treatment in association with intra-articular HA injection and showed pain relief and functional improvement. The follow-up standard weight-bearing X-ray images of knees also confirmed the improvement and indicated the possibility of regeneration of the articular cartilage. These cases provide clinical and radiographic evidence for a new therapy for advanced knee OA. This treatment strategy of PRP in association with HA injection can offer a chance to treat severe knee OA, rather than immediate surgery, or a chance for those who cannot undergo surgery. It can also postpone the need of arthroplasty and can significantly improve the daily activity function.
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Affiliation(s)
- Szu-Hsuan Chen
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung
| | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, College of Medicine; Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Mu-Jung Kao
- Department of Rehabilitation, Taipei City Hospital, Zhong Xiao Branch, Taipei
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung; Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China
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Gungor HR, Ok N, Agladioglu K. Comment on: Measurement of the knee joint line in Turkish population. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:480-1. [PMID: 27522315 PMCID: PMC6197159 DOI: 10.1016/j.aott.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/29/2015] [Indexed: 11/20/2022]
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Abstract
The use of B cell depletion as a mode of treatment for non-Hodgkin’s lymphoma was first utilized in 1997 when Rituximab, a chimeric human-mouse monoclonal antibody which has a high affinity to the CD20 antigen expressed on B cells, became available. Over 500 000 lymphoma patients have been treated worldwide with this drug and it has a good safety record. The notion that B cells might be critical to the development of rheumatoid arthritis led to the extension of the use of B cell depletion to this condition and a recent double blind controlled trial has shown very encouraging results. In addition, B cell depletion either using Rituximab alone, or in combination with cyclophosphamide and corticosteroids has also been reported to have been of great benefit in some patients with severe systemic lupus erythematosus albeit in open label studies. This review considers the mechanism of action of the drug, the clinical trials that have been reported, and tries to place its current use in patients with autoimmune rheumatic disease in context.
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Affiliation(s)
- S A Chambers
- Centre for Rheumatology, The Middlesex Hospital, University College, London, UK
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Komatsu D, Ikeuchi K, Kojima T, Takegami Y, Amano T, Tsuboi M, Ishiguro N, Hasegawa Y. Laterality of radiographic osteoarthritis of the knee. Laterality 2016; 22:340-353. [PMID: 27348458 DOI: 10.1080/1357650x.2016.1199560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There are few reports of the laterality in radiological knee osteoarthritis (ROA). This study aimed to evaluate laterality in terms of the minimum joint space width (mJSW) and osteophyte areas (OFs) in a cross-sectorial general population screen and elucidate the association between laterality and risk of osteoarthritis. We enrolled 330 participants (mean age 64.6 years) and examined the presence of ROA (Kellgren-Lawrence grade ≧ 2) laterality in terms of the mJSW and OF on the medial tibia using auto-measuring software. Moreover, we examined the association between laterality and leg dominance. The right and left medial mJSWs were 4.02 ± 0.98 mm and 4.05 ± 1.01 mm, respectively, showing no laterality; the laterals were also similar. The participants who had osteophytes ≥1 mm2 in the right, left, and bilateral knees were 15, 37, and 57 respectively, with osteophytes being significantly more common in the left knee. The OF was significantly larger in the left knee. Conversely, the medial and lateral mJSWs and OF did not differ according to leg dominance. The prevalence of ROA was higher and the OF was more pronounced in the left knee. However, the mJSW showed no laterality. Additionally, the mJSW and OF showed no differences according to leg dominance.
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Affiliation(s)
- Daigo Komatsu
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Aichi , Japan
| | - Kazuma Ikeuchi
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Aichi , Japan
| | - Toshihisa Kojima
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Aichi , Japan
| | - Yasuhiko Takegami
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Aichi , Japan
| | - Takafumi Amano
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Aichi , Japan
| | | | - Naoki Ishiguro
- a Department of Orthopaedic Surgery , Nagoya University Graduate School of Medicine , Aichi , Japan
| | - Yukiharu Hasegawa
- c Department of Hip and Knee Reconstructive Surgery , Nagoya University Graduate School of Medicine , Aichi , Japan
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Bone and joint modeling from 3D knee MRI: feasibility and comparison with radiographs and 2D MRI. Clin Imaging 2016; 40:765-8. [PMID: 27317222 DOI: 10.1016/j.clinimag.2016.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/11/2016] [Accepted: 02/17/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose was to evaluate feasibility of bone and joint segmentations from three-dimensional magnetic resonance imaging (3D MRI). METHODS Segmented joint models from 3D MRI data set were obtained for 42 patients. Blinded angular and joint space measurements were performed on 3D MRI model, two-dimensional (2D) MRI, and radiography (XR). RESULTS Medial joint space was similar on both XR and 3D MRI (P=.3). The XR measurements were statistically different but closer to 3D MRI for lateral patellar tilt angle, patellar tendon length, and lateral knee joint space, whereas 2D MRI measurements were closer to XR in terms of trochlear depth, sulcal angle, and patellar length. CONCLUSION 3D bone and joint segmentations are feasible from isotropic MRI data sets.
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Weber E, Theisen D, Wilmes P, Menetrey J, Hulet C, Seil R. A new quantitative measure for radiologic osteoarthritis of the lateral knee compartment distinguishes patients with longstanding lateral meniscectomy from non-pathological knees. Knee Surg Sports Traumatol Arthrosc 2016; 24:1569-74. [PMID: 27026028 DOI: 10.1007/s00167-016-4084-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/08/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Common radiologic scores to evaluate knee osteoarthritis (OA) have been widely used but are descriptive and may lack objectivity. The aim of this study was to develop a quantitative and objective radiologic measure for the evaluation of lateral knee compartment OA. Furthermore, we tested the reliability of this new measure and its correlation to well-accepted radiologic scores. METHODS This retrospective study was performed within the context of a multi-centre long-term follow-up (15-25 years) of a patient cohort after partial or total lateral meniscectomy (n = 36 knees). In addition, 99 radiographs of clinically and radiologically normal knees were obtained from a control group. Anteroposterior weight-bearing views (0°) and Schuss (45°) views were analysed. The joint height of the lateral knee compartment was measured on the lateral border (lateral joint space height) and in the centre (central joint space height, CJSH) and normalized with respect to the width of the lateral compartment (X). All measurements were taken independently by two observers, allowing for inter- and intra-observer reliability assessments. The results of the two groups were compared using an analysis of covariance. Finally, the correlations between the results and the Fairbank and Kellgren & Lawrence scores were determined using a Spearman ρ rank order correlation. RESULTS The normalized joint space height in the centre of the compartment on the Schuss view (CJSH/X) showed the highest intra- (ICC = 0.980) and inter-observer reliability (ICC = 0.982). There was a significant difference in CJSH/X between the control (0.19 ± 0.05) and the meniscectomized knees (0.08 ± 0.07) (p < 0.001). CJSH/X showed a significant decline of 11 % per 10 years in the meniscectomy group. A negative correlation could be found between CJSH/X and the Fairbank (ρ = -0.751; p < 0.001) and Kellgren & Lawrence scores (ρ = -0.712; p < 0.001). A cut-off value of 0.14 of CJSH/X was defined-representing one standard deviation below the mean of the control group-from which measurements were considered as pathologic. CONCLUSION The normalized joint space height measured in the centre of the lateral knee compartment from a Schuss view, CJSH/X, was highly reproducible and showed a significant correlation to established radiologic scores. This new measure has the advantage of being objective and dimensionless and thus independent of the size of the radiograph. The normative values provided by our healthy control knees are useful to help establish an early diagnosis of radiologic lateral knee compartment OA. LEVEL OF EVIDENCE Retrospective diagnostic study, Level III.
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Affiliation(s)
- Esther Weber
- Clinique du Sport, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | | | - Jacques Menetrey
- Service de chirurgie orthopédique et traumatologie de l'appareil moteur, Unité d'orthopédie et traumatologie du sport, Swiss Olympic Medical Center, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Christophe Hulet
- Unit Comete INSERM U1075 UCBN EA3917, Orthopedic Department, Caen University Hospital, Caen Lower Normandy University, Caen, France
| | - Romain Seil
- Clinique du Sport, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
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Komatsu D, Hasegawa Y, Kojima T, Seki T, Ikeuchi K, Takegami Y, Amano T, Higuchi Y, Kasai T, Ishiguro N. Validity of radiographic assessment of the knee joint space using automatic image analysis. Mod Rheumatol 2016; 26:761-6. [PMID: 26707091 DOI: 10.3109/14397595.2015.1130679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The present study investigated whether there were differences between automatic and manual measurements of the minimum joint space width (mJSW) on knee radiographs. METHODS Knee radiographs of 324 participants in a systematic health screening were analyzed using the following three methods: manual measurement of film-based radiographs (Manual), manual measurement of digitized radiographs (Digital), and automatic measurement of digitized radiographs (Auto). The mean mJSWs on the medial and lateral sides of the knees were determined using each method, and measurement reliability was evaluated using intra-class correlation coefficients. Measurement errors were compared between normal knees and knees with radiographic osteoarthritis. RESULTS All three methods demonstrated good reliability, although the reliability was slightly lower with the Manual method than with the other methods. On the medial and lateral sides of the knees, the mJSWs were the largest in the Manual method and the smallest in the Auto method. The measurement errors of each method were significantly larger for normal knees than for radiographic osteoarthritis knees. CONCLUSIONS The mJSW measurements are more accurate and reliable with the Auto method than with the Manual or Digital method, especially for normal knees. Therefore, the Auto method is ideal for the assessment of the knee joint space.
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Affiliation(s)
| | - Yukiharu Hasegawa
- b Department of Hip and Knee Reconstructive Surgery , Nagoya University Graduate School of Medicine , Aichi , Japan
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Trencart P, Alexander K, De Lasalle J, Laverty S. Radiographic evaluation of the width of the femorotibial joint space in horses. Am J Vet Res 2016; 77:127-36. [DOI: 10.2460/ajvr.77.2.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The Combination of the Tunnel View and Weight-Bearing Anteroposterior Radiographs Improves the Detection of Knee Arthritis. ARTHRITIS 2016; 2016:9786924. [PMID: 26925264 PMCID: PMC4746274 DOI: 10.1155/2016/9786924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022]
Abstract
Imaging used for the evaluation of knee pain has historically included weight-bearing anteroposterior (AP), lateral, and sunrise radiographs. We wished to evaluate the utility of adding the weight-bearing (WB) posteroanterior (PA) view of the knee in flexion. We hypothesize that (1) the WB tunnel view can detect radiographic osteoarthritis (OA) not visualized on the WB AP, (2) the combination of the AP and tunnel view increases the radiographic detection of OA, and (3) this may provide additional information to the clinician evaluating knee pain. We retrospectively reviewed the WB AP and tunnel view radiographs of 100 knees (74 patients) presenting with knee pain and analyzed for evidence of arthritis. The combination of the WB tunnel view and WB AP significantly increased the detection of joint space narrowing in the lateral (p < 0.001) and medial (p = 0.006) compartments over the AP view alone. The combined views significantly improved the identification of medial subchondral cysts (p = 0.022), sclerosis of the lateral tibial plateau (p = 0.041), and moderate-to-large osteophytes in the medial compartment (p = 0.012), intercondylar notch (p < 0.001), and tibial spine (p < 0.001). The WB tunnel view is an effective tool to provide additional information on affected compartments in the painful knee, not provided by the AP image alone.
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Evaluation of Single-Impact-Induced Cartilage Degeneration by Optical Coherence Tomography. BIOMED RESEARCH INTERNATIONAL 2015; 2015:486794. [PMID: 26229959 PMCID: PMC4502276 DOI: 10.1155/2015/486794] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 01/19/2023]
Abstract
Posttraumatic osteoarthritis constitutes a major cause of disability in our increasingly elderly population. Unfortunately, current imaging modalities are too insensitive to detect early degenerative changes of this disease. Optical coherence tomography (OCT) is a promising nondestructive imaging technique that allows surface and subsurface imaging of cartilage, at near-histological resolution, and is principally applicable in vivo during arthroscopy. Thirty-four macroscopically normal human cartilage-bone samples obtained from total joint replacements were subjected to standardized single impacts in vitro (range: 0.25 J to 0.98 J). 3D OCT measurements of impact area and adjacent tissue were performed prior to impaction, directly after impaction, and 1, 4, and 8 days later. OCT images were assessed qualitatively (DJD classification) and quantitatively using established parameters (OII, Optical Irregularity Index; OHI, Optical Homogeneity Index; OAI, Optical Attenuation Index) and compared to corresponding histological sections. While OAI and OHI scores were not significantly changed in response to low- or moderate-impact energies, high-impact energies significantly increased mean DJD grades (histology and OCT) and OII scores. In conclusion, OCT-based parameterization and quantification are able to reliably detect loss of cartilage surface integrity after high-energy traumatic insults and hold potential to be used for clinical screening of early osteoarthritis.
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Hunter DJ, Altman RD, Cicuttini F, Crema MD, Duryea J, Eckstein F, Guermazi A, Kijowski R, Link TM, Martel-Pelletier J, Miller CG, Mosher TJ, Ochoa-Albíztegui RE, Pelletier JP, Peterfy C, Raynauld JP, Roemer FW, Totterman SM, Gold GE. OARSI Clinical Trials Recommendations: Knee imaging in clinical trials in osteoarthritis. Osteoarthritis Cartilage 2015; 23:698-715. [PMID: 25952343 DOI: 10.1016/j.joca.2015.03.012] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
Significant advances have occurred in our understanding of the pathogenesis of knee osteoarthritis (OA) and some recent trials have demonstrated the potential for modification of the disease course. The purpose of this expert opinion, consensus driven exercise is to provide detail on how one might use and apply knee imaging in knee OA trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for magnetic resonance imaging (MRI)); commonly encountered problems (including positioning, hardware and coil failures, sequences artifacts); quality assurance (QA)/control procedures; measurement methods; measurement performance (reliability, responsiveness, validity); recommendations for trials; and research recommendations.
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Affiliation(s)
- D J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia; Rheumatology Department, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia.
| | - R D Altman
- Department of Medicine, Division of Rheumatology and Immunology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - F Cicuttini
- School of Public health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne 3004, Australia
| | - M D Crema
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
| | - J Duryea
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brazil
| | - F Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - R Kijowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - T M Link
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, USA
| | - J Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | | | - T J Mosher
- Department of Radiology, Penn State University, Hershey, PA, USA; Department of Orthopaedic Surgery, Penn State University, Hershey, PA, USA
| | - R E Ochoa-Albíztegui
- Department of Radiology, The American British Cowdray Medical Center, Mexico City, Mexico
| | - J-P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - C Peterfy
- Spire Sciences, Inc., Boca Raton, Florida, USA
| | - J-P Raynauld
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - G E Gold
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
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Yang S, Eaton CB, McAlindon TE, Lapane KL. Effects of glucosamine and chondroitin supplementation on knee osteoarthritis: an analysis with marginal structural models. Arthritis Rheumatol 2015; 67:714-23. [PMID: 25369761 DOI: 10.1002/art.38932] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 10/23/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate the effectiveness of the combination of glucosamine and chondroitin in relieving knee symptoms and slowing disease progression among patients with knee osteoarthritis (OA). METHODS The 4-year followup data from the Osteoarthritis Initiative data set were analyzed. We used a "new-user" design, for which only participants who were not using glucosamine/chondroitin at baseline were included in the analyses (n = 1,625). Cumulative exposure was calculated as the number of visits when participants reported use of glucosamine/chondroitin. Knee symptoms were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and structural progression was determined by measuring the joint space width (JSW). To control for the time-varying confounders that might be influenced by previous treatments, we used marginal structural models to estimate the effects on OA of using glucosamine/chondroitin for 3 years, 2 years, and 1 year. RESULTS During the study period, 18% of the participants initiated treatment with glucosamine/chondroitin. After adjustment for potential confounders with marginal structural models, we found no clinically significant differences between users at all assessments and never-users of glucosamine/chondroitin in WOMAC pain (β = 0.68 [95% confidence interval (95% CI) -0.16 to 1.53]), WOMAC stiffness (β = 0.41 [95% CI 0 to 0.82]), and WOMAC function (β = 1.28 [95% CI -1.23 to 3.79]) or JSW (β = 0.11 [95% CI -0.21 to 0.44]). CONCLUSION Use of glucosamine/chondroitin did not appear to relieve symptoms or modify disease progression among patients with radiographically confirmed OA. Our findings are consistent with the results of meta-analyses of clinical trials and extend those results to a more general population with knee OA.
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Duncan ST, Khazzam MS, Burnham JM, Spindler KP, Dunn WR, Wright RW. Sensitivity of standing radiographs to detect knee arthritis: a systematic review of Level I studies. Arthroscopy 2015; 31:321-8. [PMID: 25312767 DOI: 10.1016/j.arthro.2014.08.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/10/2014] [Accepted: 08/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review of the available literature to define the level of quality evidence for determining the sensitivity and specificity of different radiographic views in detecting knee osteoarthritis and to determine the impact of different grading systems on the ability to detect knee osteoarthritis. METHODS A systematic review of the literature was conducted to identify studies that evaluated the standing anteroposterior (AP) and 45° posteroanterior (PA) views for tibiofemoral and patellofemoral arthritis and those comparing the use of the Kellgren-Lawrence versus the joint space narrowing (JSN) radiographic grading systems using arthroscopy as the gold standard. A comprehensive search of PubMed, Scopus, CINAHL, the Cochrane Database, Clinicaltrial.gov, and EMBASE was performed using the keywords "osteoarthritis," "knee," "x-ray," "sensitivity," and "arthroscopy." RESULTS Six studies were included in the evaluation. The 45° flexion PA view showed a higher sensitivity than the standing AP view for detecting severe arthritis involving either the medial or lateral tibiofemoral compartment. There was no difference in the specificities for the 2 views. The direct comparison of the Kellgren-Lawrence and the JSN radiographic grading systems found no clinical difference between the 2 systems regarding the sensitivities, although the specificity was greater for the JSN system. CONCLUSIONS The ability to detect knee osteoarthritis continues to be difficult without using advanced imaging. However, as an inexpensive screening tool, the 45° flexion PA view is more sensitive than the standing AP view to detect severe tibiofemoral osteoarthritis. When evaluating the radiograph for severe osteoarthritis using either the Kellgren-Lawrence or JSN grading system, there is no clinical difference in the sensitivity between the 2 methods; however, the JSN may be more specific for ruling in severe osteoarthritis in the medial compartment. LEVEL OF EVIDENCE Level I, systematic review of Level I studies.
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Affiliation(s)
- Stephen T Duncan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A..
| | - Michael S Khazzam
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic Sports Health Center, Cleveland, Ohio, U.S.A
| | - Warren R Dunn
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Rick W Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, Missouri, U.S.A
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Imaging of cartilage and bone: promises and pitfalls in clinical trials of osteoarthritis. Osteoarthritis Cartilage 2014; 22:1516-32. [PMID: 25278061 PMCID: PMC4351816 DOI: 10.1016/j.joca.2014.06.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/22/2014] [Accepted: 06/22/2014] [Indexed: 02/02/2023]
Abstract
Imaging in clinical trials is used to evaluate subject eligibility, and/or efficacy of intervention, supporting decision making in drug development by ascertaining treatment effects on joint structure. This review focusses on imaging of bone and cartilage in clinical trials of (knee) osteoarthritis. We narratively review the full-text literature on imaging of bone and cartilage, adding primary experience in the implementation of imaging methods in clinical trials. Aims and constraints of applying imaging in clinical trials are outlined. The specific uses of semi-quantitative and quantitative imaging biomarkers of bone and cartilage in osteoarthritis trials are summarized, focusing on radiography and magnetic resonance imaging (MRI). Studies having compared both imaging methodologies directly and those having established a relationship between imaging biomarkers and clinical outcomes are highlighted. To make this review of practical use, recommendations are provided as to which imaging protocols are ideal for capturing specific aspects of bone and cartilage tissue, and pitfalls in their usage are highlighted. Further, the longitudinal sensitivity to change, of different imaging methods is reported for various patient strata. From these power calculations can be accomplished, provided the strength of the treatment effect is known. In conclusion, current imaging methodologies provide powerful tools for scoring and measuring morphological and compositional aspects of most articular tissues, capturing longitudinal change with reasonable to excellent sensitivity. When employed properly, imaging has tremendous potential for ascertaining treatment effects on various joint structures, potentially over shorter time scales than required for demonstrating effects on clinical outcomes.
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Correlation of WOMAC and KOOS scores to tibiofemoral cartilage loss on plain radiography and 3 Tesla MRI: data from the osteoarthritis initiative. Knee Surg Sports Traumatol Arthrosc 2014; 22:1649-58. [PMID: 23338667 DOI: 10.1007/s00167-013-2402-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 01/14/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study was to determine the correlation between the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) and Knee Injury Osteoarthritis Outcomes scores (KOOS) and the degree of tibiofemoral cartilage loss on plain radiography and 3T magnetic resonance imaging (MRI). We hypothesize that these subjective outcome scores will have a significant correlation to quantitative joint space loss. METHODS Data used in the preparation of this article were obtained from the osteoarthritis initiative (OAI) database (OAI public use data sets kMRI_QCart_Eckstein18 and kXR_QJSW_Duryea16). Four hundred and forty-five patients had WOMAC/KOOS scores, quantitative tibiofemoral joints space width on plain radiographs and quantitative tibiofemoral cartilage thickness and per cent full thickness cartilage loss on 3T MRI. Joint space width on plain radiographs was correlated to cartilage thickness on MRI, and WOMAC/KOOS scores were correlated to the degree of cartilage loss using Pearson correlation coefficients. RESULTS There was a statistically significant correlation between medial and lateral compartment cartilage thickness on MRI and medial and lateral joint space width on plain radiography (r = 0.86, r = 0.80) (p < 0.001). KOOS knee pain score was significantly correlated to increasing per cent full thickness cartilage loss in the medial femoral compartment (r = 0.34) (p < 0.001). KOOS symptom score was significantly correlated to decreasing joint space width in the medial (r = 0.16) and lateral (r = 0.15) compartment and increasing per cent full thickness cartilage loss in the medial femoral compartment (r = 0.36) (p < 0.001). No WOMAC score was correlated to degree of joint space width, cartilage thickness or per cent full thickness cartilage loss (n.s). CONCLUSION The WOMAC and KOOS scores are poor indicators of tibiofemoral cartilage loss, with only the KOOS symptom and knee pain score being weakly correlated. Osteoarthritis is a multifactorial process and the need to treat patients based off their symptoms and rely on radiographs as confirmatory modalities, and not diagnostic modalities, when talking about OA and medical intervention.
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Theoretical prediction of ultrasound elastography for detection of early osteoarthritis. ScientificWorldJournal 2013; 2013:565717. [PMID: 24307873 PMCID: PMC3836411 DOI: 10.1155/2013/565717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/01/2013] [Indexed: 12/20/2022] Open
Abstract
Ultrasound elastography could be used as a new noninvasive technique for detecting early osteoarthritis. As the first critical step, this study theoretically predicted the excitation power and the measurement errors in detecting cartilage detect. A finite element model was used to simulate wave propagation of elastography in the cartilage. The wave was produced by a force F, and the wave speed C was calculated. The normal cartilage model was used to define the relationship between the wave speed and elastic modulus. Various stiffness values were simulated. F = 10 N with a duration of 0.5 ms was required for having measurable deformation (10 μm) at the distal site. The deformation had a significant rise when the wave crossed the defect. The relationship between the wave speed and elastic parameters was found as C = 1.57 × (E)/(2 × ρ(1+μ)))1/2, where E was the elastic modulus, μ was Poisson's ratio, and ρ was the density. For the simulated defect with an elastic modulus of 7 MPa which was slightly stiffer than the normal cartilage, the measurement error was 0.1 MPa. The results suggested that, given the simulated conditions, this new technique could be used to detect the defect in early osteoarthritis.
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Bloecker K, Wirth W, Hunter DJ, Duryea J, Guermazi A, Kwoh CK, Resch H, Eckstein F. Contribution of regional 3D meniscus and cartilage morphometry by MRI to joint space width in fixed flexion knee radiography--a between-knee comparison in subjects with unilateral joint space narrowing. Eur J Radiol 2013; 82:e832-9. [PMID: 24119428 DOI: 10.1016/j.ejrad.2013.08.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/29/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Radiographic joint space width (JSW) is considered the reference standard for demonstrating structural therapeutic benefits in knee osteoarthritis. Our objective was to determine the proportion by which 3D (regional) meniscus and cartilage measures explain between-knee differences of JSW in the fixed flexion radiographs. METHODS Segmentation of the medial meniscus and tibial and femoral cartilage was performed in double echo steady state (DESS) images. Quantitative measures of meniscus size and position, femorotibial cartilage thickness, and radiographic JSW (minimum, and fixed locations) were compared between both knees of 60 participants of the Osteoarthritis Initiative, with strictly unilateral medial joint space narrowing (JSN). Statistical analyses (between-knee, within-person comparison) were performed using regression analysis. RESULTS A strong relationship with side-differences in minimum and a central fixed location JSW was observed for percent tibial plateau coverage by the meniscus (r = .59 and .47; p<.01) and central femoral cartilage thickness (r = .69 and .75; p<.01); other meniscus and cartilage measures displayed lower coefficients. The correlation of central femoral cartilage thickness with JSW (but not that of meniscus measures) was greater (r = .78 and .85; p<.01) when excluding knees with non-optimal alignment between the tibia and X-ray beam. CONCLUSION 3D measures of meniscus and cartilage provide significant, independent information in explaining side-differences in radiographic JSW in fixed flexion radiographs. Tibial coverage by the meniscus and central femoral cartilage explained two thirds of the variability in minimum and fixed location JSW. JSW provides a better representation of (central) femorotibial cartilage thickness, when optimal positioning of the fixed flexion radiographs is achieved.
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Affiliation(s)
- K Bloecker
- Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria; Department of Traumatology and Sports Medicine, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.
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Abstract
CLINICAL/METHODICAL ISSUE Osteoarthritis is the most common degenerative age-related joint disease leading to typical degradation of articular cartilage with severe pain and limitation of joint motion. STANDARD RADIOLOGICAL METHODS Although knee radiographs are widely considered as the gold standard for the assessment of knee osteoarthritis in clinical and scientific settings they increasingly have significant limitations in situations when resolution and assessment of cartilage is required. METHODICAL INNOVATIONS Analysis of osteoarthritis of the knee with conventional x-ray is associated with many technical limitations and is increasingly being replaced by high-quality assessment using magnetic resonance imaging (MRI) or sonography both in the clinical routine and scientific studies. PERFORMANCE Novel imaging modalities such as MRI or ultrasound enable in vivo visualization of the quality of the cartilaginous structure and bone as well as all articular and periarticular tissue. Therefore, the limitations of radiographs in assessment of knee osteoarthritis could be overcome by these techniques. This review article aims to provide insights into the most important radiological features of knee osteoarthritis and systematic visualization with different imaging approaches. PRACTICAL RECOMMENDATIONS The demographic development in western industrialized countries predicts an increase of ageing-related osteoarthritis of the knee for the next decades. A systematic radiological evaluation of patients with knee osteoarthritis includes the assessment of the periarticular soft tissue, cartilaginous thickness, cartilage volume, possible cartilage defects, the macromodular network of hyaline cartilage, bone marrow edema, menisci and articular ligaments. Modern imaging modalities, such as MRI and sonography allow the limitations of conventional radiography to be overcome and to visualize the knee structures in great detail to quantitatively assess the severity of knee osteoarthritis.
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Laxafoss E, Jacobsen S, Gosvig KK, Sonne-Holm S. The alignment of the knee joint in relationship to age and osteoarthritis: the Copenhagen Osteoarthritis Study. Skeletal Radiol 2013; 42:531-40. [PMID: 22965223 DOI: 10.1007/s00256-012-1509-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/30/2012] [Accepted: 08/19/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of the present study was to describe the changes in the axis of the knee joint in both radiologically osteoarthritic and non-osteoarthritic knees, on the basis of angles measurable in standardized clinical short knee radiographs, in a cross sectional study of an epidemiological cohort. DESIGN From the third inclusion of the Copenhagen City Heart Study, 4,151 subjects were selected for standardized radiography of the knees. After censuring the inclusion, the resulting cohort was comprised of 3,488 individuals. Images were analyzed for radiological knee joint osteoarthritis (OA) and the anatomical femorotibial axis of the knee joint was measured. RESULTS The prevalence of knee joint OA in males was 27.9% and 27.5%, for the left and right knees respectively. In females this was 32.8% and 36.4%. The mean knee joint angles were 4.11° in males; and 5.45° in females. A difference of 1.3° was found between the genders. In non-osteoarthritic knees the increase in valgus orientation in relationship to increasing age was found to be 0.03° and 0.04° per year, respectively, for males and females. Likewise, Kellgren and Lawrence found that OA was seen to influence a shift towards varus of 0.55°-0.76° per level of OA. CONCLUSION Stratification in accordance with morphological severity of OA documented a clear tendency for the axis of the diseased knees to depart from the mean, primarily in the direction of varus. In knees exhibiting no signs of radiographic osteoarthritis we found a significant relationship between increasing age and a shift in the anatomical axis in the direction of valgus.
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Affiliation(s)
- Erling Laxafoss
- Department of Orthopaedic Surgery, Copenhagen University Hospital of Hvidovre, Kettegaards Allé 30, 2650, Hvidovre, Denmark.
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