Fixed-flexion view X-ray of the knee superior in detection and follow-up of knee osteoarthritis

Hiroyuki Kan, Yuji Arai, Masashi Kobayashi, Shuji Nakagawa, Hiroaki Inoue, Manabu Hino, Shintaro Komaki, Kazuya Ikoma, Keiichiro Ueshima, Hiroyoshi Fujiwara, Isao Yokota, Toshikazu Kubo, Hiroyuki Kan, Yuji Arai, Masashi Kobayashi, Shuji Nakagawa, Hiroaki Inoue, Manabu Hino, Shintaro Komaki, Kazuya Ikoma, Keiichiro Ueshima, Hiroyoshi Fujiwara, Isao Yokota, Toshikazu Kubo

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.

Conflict of interest statement

We declare there is no conflict of interest.

Figures

Figure 1
Figure 1
The patient stood in front of the film cassette, with the posterior thigh in contact with the cassette. Irradiation was applied in the horizontal direction.
Figure 2
Figure 2
The patient stood with a 10° external rotation of the feet, with the anterior thigh in close contact with the cassette and the tips of the toes on the same plane as that of the cassette. A posteroanterior image was acquired at an irradiation angle of 10° tilt in the caudal direction.
Figure 3
Figure 3
The medial joint space width (MJSW) was defined the distance between the apex of the medial condyle of the femur and the tibial posterior end.
Figure 4
Figure 4
ΔSEV did not differ significantly among the KL grade groups.
Figure 5
Figure 5
ΔFFV was significantly greater in patients with KL grade II than in patients with other KL grades.
Figure 6
Figure 6
The MJSW values were smaller in the FFV than SEV group for all patients.

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Source: PubMed

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