Alignment of the medial tibial plateau affects the rate of joint space narrowing in the osteoarthritic knee

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• 作者：E. Vignon ; K.D. Br ; t ; C. Mercier ; M. Hochberg ; D. Hunter ; S. Mazzuca ; K. Powell ; B. Wyman ; M.-P. Hellio Le Graver
• 关键词：Knee osteoarthritis ; Joint space narrowing ; Tibial plateau alignment ; Standardized radiography
• 刊名：Osteoarthritis and Cartilage
• 出版年：2010
• 出版时间：November 2010
• 年：2010
• 卷：18
• 期：11
• 页码：1436-1440
• 全文大小：278 K

文摘

Summary

Objective

To determine, in serial fixed-flexion (FF) radiographs of subjects with knee osteoarthritis (KOA), the importance of, and basis for, the effect of alignment of the medial tibial plateau (MTP), as determined by the inter-margin distance (IMD), on joint space narrowing (JSN).

Methods

Baseline and 12-month X-rays of 590 knees with Kellgren and Lawrence grade (KLG) 2/3 OA from the public-release dataset of the Osteoarthritis Initiative (OAI) were assigned to subgroups based upon IMD at baseline (IMD_BL) and the difference between IMD_BL and IMD_12mos. Relationships of JSN to IMD_BL and to the difference between IMD_{BL and} IMD_12mos were evaluated.

Results

In all 590 knees, mean JSN was 0.13 ± 0.51 mm (P < 0.0001) and MTP alignment and replication of IMD_BL in the 12-month film were, in general, poor. JSN was significantly (P = 0.012) more rapid in Subgroup A (IMD ≤ 1.70 mm at both time points) than in Subgroup B (both IMDs > 1.70 mm): 0.15 ± 0.43; 0.08 ± 0.47. Within Subgroup B we identified a subset, Subgroup B1, in which, although alignment was poor at both time points, the large IMD_BL was, by chance, highly reproduced by IMD_12mos (difference between the two IMDs = 0.01 ± 0.27 mm, NS). JSN in Subgroup B1 was 0.06 ± 0.41 mm and did not differ from that in other knees of Subgroup B (P = 0.87). The standardized response mean (SRM) in all 590 knees and Subgroups A, B and B1 was 0.25, 0.34, 0.17 and 0.06, respectively. Independent of IMD_BL, JSN correlated significantly with the difference between the IMDs in the two radiographs (r = 0.17, P = 0.0001).

Conclusion

Skewed MTP alignment in serial films and poor replication of IMD_BL in the follow-up exam affect JSN measurement. The magnitude of change in joint space width (JSW) related to the poor quality of alignment that is common with the FF view jeopardizes accurate evaluation of JSN.