Christian-Hubert Roux1, Bernard Mazieres2, Evelyne Verrouil2, Anne-Christine Rat3, Patrice Fardellone4, Bruno Fautrel5, Jacques Pouchot6, Alain Saraux7, Francis Guillemin3, Liana Euller-Ziegler8, Joël Coste9. 1. Rheumatology Department, LAHMESS Laboratory EA 6309, University Sophia-Antipolis, hôpital l'Archet 1, CHU de Nice, 262, avenue Saint-Antoine-de-Ginestière, 06202 Nice, France. Electronic address: roux101fr@yahoo.fr. 2. Department of Rheumatology, Purpan University Hospital, 31059 Toulouse cedex 9, France. 3. EA 4360 Apemac, Lorraine University, 54505 Vandœuvre-lès-Nancy, France. 4. Inserm ERI 12, service de rhumatologie, Amiens University Hospital, CHU Nord, 80080 Amiens, France. 5. Department of Rheumatology, université Pierre-et-Marie-Curie - Sorbonne universités, AP-HP (Assistance publique-hôpitaux de Paris), Pitié-Salpêtrière Hospital, 75013 Paris, France. 6. Department of Internal Medicine, Assistance publique-hôpitaux de Paris, hôpital européen Georges-Pompidou, 75908 Paris, France. 7. Rheumatology Department, Cavale-Blanche, University Hospital and EA 2216, université Bretagne occidentale, 29609 Brest cedex, France. 8. Rheumatology Department, LAHMESS Laboratory EA 6309, University Sophia-Antipolis, hôpital l'Archet 1, CHU de Nice, 262, avenue Saint-Antoine-de-Ginestière, 06202 Nice, France. 9. Biostatistics and Epidemiology Unit, Assistance publique-hôpitaux de Paris, Hôtel-Dieu, 75004 Paris, France.
Abstract
OBJECTIVE: Our objective was to compare the use of both anteroposterior (AP) extended-knee X-ray and semi-flexed X-ray (current gold standard) versus the use of semi-flexed X-ray alone to detect femoro-tibial osteoarthritis (OA). METHODS: Individuals 40 to 75 years of age with symptomatic hip and/or knee OA (Kellgren/Lawrence [KL] score≥2) were recruited using a multiregional prevalence survey in France. Both AP and schuss X-rays were performed and read; two years later, the same examiner, blinded to the results of the first reading, performed a second reading of the schuss X-ray. We compared the KL stages of each knee and analyzed osteophyte detection and localization, joint space narrowing (JSN), and the relationship to obesity. RESULTS: The analysis included 350 participants with OA of various stages. Comparing the two readings showed that a higher proportion of patients had KL≥2 when the two X-ray views were combined (right knee: P<0.0001; left knee: P<0.001). There were no differences when using the schuss X-ray alone versus in combination with an AP X-ray in terms of detecting JSN, osteophytes. A comparison of schuss X-ray alone versus AP X-ray alone demonstrated the superiority of the schuss view for evaluating JSN (P=0.0001 and P=0.0001) and no difference in osteophyte detection. CONCLUSION: Our study shows that the schuss view alone was sufficient for detecting knee osteophytes and JSN. Using one X-ray rather than two will reduce medical costs and irradiation burden. Using two views seems preferable for epidemiological studies.
OBJECTIVE: Our objective was to compare the use of both anteroposterior (AP) extended-knee X-ray and semi-flexed X-ray (current gold standard) versus the use of semi-flexed X-ray alone to detect femoro-tibial osteoarthritis (OA). METHODS: Individuals 40 to 75 years of age with symptomatic hip and/or knee OA (Kellgren/Lawrence [KL] score≥2) were recruited using a multiregional prevalence survey in France. Both AP and schuss X-rays were performed and read; two years later, the same examiner, blinded to the results of the first reading, performed a second reading of the schuss X-ray. We compared the KL stages of each knee and analyzed osteophyte detection and localization, joint space narrowing (JSN), and the relationship to obesity. RESULTS: The analysis included 350 participants with OA of various stages. Comparing the two readings showed that a higher proportion of patients had KL≥2 when the two X-ray views were combined (right knee: P<0.0001; left knee: P<0.001). There were no differences when using the schuss X-ray alone versus in combination with an AP X-ray in terms of detecting JSN, osteophytes. A comparison of schuss X-ray alone versus AP X-ray alone demonstrated the superiority of the schuss view for evaluating JSN (P=0.0001 and P=0.0001) and no difference in osteophyte detection. CONCLUSION: Our study shows that the schuss view alone was sufficient for detecting knee osteophytes and JSN. Using one X-ray rather than two will reduce medical costs and irradiation burden. Using two views seems preferable for epidemiological studies.