Impact of the joint space width measurement method on the design of knee osteoarthritis studies

Bruyère, Olivier; Henrotin, Yves; Honoré, Aline; Rovati, Lucio C.; Seidel, Laurence; Dardenne, Charles-Bernard; Reginster, Jean‐Yves

doi:10.1007/bf03324491

Cited by 22 publications

(9 citation statements)

References 18 publications

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“…Accordingly, measurement location for the midpoint method was more variable. Although studies have shown that computer-assisted methods are more sensitive and reliable than manual methods, 9,15 our findings support the need to use complete computerization and standardization of methods to eliminate user error altogether. If the midpoint method is used, this error could potentially be reduced by ensuring proper and adequate training of the investigator to increase consistency of selected points as well as choosing high-quality radiographs to make anatomic landmarks as clear as possible.…”

Section: Discussionmentioning

confidence: 51%

Comparison of 2 Radiographic Techniques for Measurement of Tibiofemoral Joint Space Width

Mehta

Duryea

Badger

et al. 2017

Orthopaedic Journal of Sports Medicine

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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 (σ2 within, 0.064; 95% CI, 0.04-0.09) compared with the midpoint method (σ2 within, 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 (σ2 within, 0.27; 95% CI, 0.18-0.43) and the midpoint method (σ2 within, 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 ...

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Section: Discussionmentioning

confidence: 51%

Comparison of 2 Radiographic Techniques for Measurement of Tibiofemoral Joint Space Width

Mehta

Duryea

Badger

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Two reports (8, 10) included data on both minimum and mean JSW. Previous comparisons of these 2 measurement approaches suggest that they have similar sensitivity to radiographic JSN (32, 41). Indeed, in the 2 studies in which a DMOAD effect was evaluated with measurements of both minimum and mean JSW (8, 10), significant differences between drug and placebo were observed with both sets of measurements.…”

Section: Structure Modificationmentioning

confidence: 99%

Lessons learned from nine clinical trials of disease‐modifying osteoarthritis drugs

Brandt¹,

Mazzuca²

2005

Arthritis & Rheumatism

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“…The choice of automated measurements of JSW at the outset of this trial was predicated on the fact that the original demonstration of the reproducibility of the SF‐AP view was based on data derived from digital image analysis of JSW (3). However, the conclusions of that study and those of subsequent reports have been inconsistent with respect to whether semiautomated measurement software is superior to manual methods with respect to reproducibility of JSW estimates and sensitivity to JSN (3, 12, 13).…”

Section: Discussionmentioning

confidence: 75%

Pitfalls in the accurate measurement of joint space narrowing in semiflexed, anteroposterior radiographic imaging of the knee

Mazzuca¹,

Brandt²,

Buckwalter³

et al. 2004

Arthritis & Rheumatism

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Objective. Computerized measurement of changes in joint space width (JSW) on serial radiographs of the knee in the semiflexed, anteroposterior (SF-AP) view has been used recently as a primary outcome measure in clinical trials of disease-modifying osteoarthritis drugs (DMOADs). In the use of fluoroscopy to achieve reproducible alignment of the medial tibial plateau and x-ray beam, the SF-AP radiographic protocol affords greater sensitivity in the detection of joint space narrowing (JSN) than that achieved by conventional radiographic positioning techniques. However, the utility of the SF-AP view is compromised by the variation in x-ray penetration in each examination, which may confound the correction of the automated measurement of JSW for the radiographic magnification inherent in an AP view of the knee. A recent DMOAD trial using the SF-AP protocol showed an improbable increase in JSW of >0.50 mm (i.e., greater than the measurement error). The present report provides an analysis of this problem, and the study aim was to demonstrate that substitution of the automated estimates of JSW with precise manual measurements can markedly reduce the problem attributable to radiographic magnification.Methods. SF-AP radiographs were obtained at baseline and at 16 months and 30 months thereafter from subjects enrolled in a 6-center DMOAD trial. For each examination, a 6.35-mm steel ball was affixed to the skin over the head of the fibula to permit estimation of the percentage of radiographic magnification (%Mag) and correction of JSW measurements. Measurements of the minimum interbone distance (IBD) in the medial tibiofemoral compartment and the %Mag were obtained by an automated method (edge detection) and manually. Combinations of automated and manual measurements of the IBD and %Mag in estimates of magnificationcorrected JSW were compared with respect to their reproducibility, agreement, and sensitivity to JSN.Results. With fully automated measurements, variations in x-ray penetration in analog radiographs and edge enhancement in digital radiographs resulted in the computer "seeing" a metal ball whose diameter was artifactually reduced, resulting in an inflated measurement of JSW. Use of manual measurement of the IBD and %Mag largely eliminated these problems and reduced, from 16% to 2%, the frequency of knees exhibiting an increase in JSW >0.50 mm. In 14 of the 15 knees in which a significant increase in JSW was noted with the manual method, this increase in JSW could be explained by the development of significant lateral compartment narrowing during the study or poor alignment of the medial plateau.Conclusion. Although automated and manual methods of JSW measurement of the knee in the SF-AP view possess comparable intrareader reproducibility, the manual method is less susceptible to technical factors that affect the correction of raw JSW estimates for radiographic magnification. Until we can identify practical, effective solutions to these technical problems, use of any radiographic protocol involving AP imaging of th...

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Impact of the joint space width measurement method on the design of knee osteoarthritis studies

Cited by 22 publications

References 18 publications

Comparison of 2 Radiographic Techniques for Measurement of Tibiofemoral Joint Space Width

Comparison of 2 Radiographic Techniques for Measurement of Tibiofemoral Joint Space Width

Lessons learned from nine clinical trials of disease‐modifying osteoarthritis drugs

Pitfalls in the accurate measurement of joint space narrowing in semiflexed, anteroposterior radiographic imaging of the knee

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