A comprehensive approach better detects knee osteoarthritis progression

Felson DT, Nevitt MC,Yang M, et al, Boston University School of Medicine and other centers.
A new approach yields high rates of radiographic progression in knee osteoarthritis.
J Rheumatol. 2008;35:2047-2054.

A comprehensive approach to detecting progression in knee osteoarthritis (OA), including all compartments and multiple views of the knee, is likely to identify far more progression than traditional approaches. Slightly more than half of progression is missed when only the medial tibiofemoral (TF) joint is targeted on the posteroanterior (PA) or anteroposterior view.

Felson and colleagues conducted a study of 606 persons with OA or at high risk for OA (842 knees). All patients underwent weight-bearing PA fixed-flexion knee and weight-bearing lateral knee radiographs.

At 30 months, 59% of knees that had radiographic OA (500 knees) showed radiographic progression; 15% of them had progression only in the patellofemoral joint, and the rest had progression in the TF joint. If only a PA view had been obtained, as in traditional studies, only 247 progressor knees would have been identified. TF progression seen only on the lateral view would not have been identified if only the PA view was used, and progression identified only in the lateral TF compartment would not have been identified using a traditional view.

The authors noted that obtaining both PA and lateral views may not be feasible because there is added expense, time, and radiation exposure.