Should all elective knee radiographs requested by general practitioners be performed weight-bearing?

Alvin Chen,Chinmay M Gupte,Elizabeth Dick,Kavita Aggarwal,Joshua Balogun-Lynch

doi:10.1186/2193-1801-3-707

Abstract

The aims of this study were to: [1] Assess the number of patients with suspected knee osteoarthritis that underwent repeat weight-bearing(WB) knee radiographs in the orthopaedic clinic following initial non-WB radiograph requested by their general practitioner (GP). [2] Confirm whether repeating WB knee views changed radiology reports. [3] Determine the number of London trusts with protocols for routinely performing WB views. A Retrospective cohort study of 1968 patients aged >40 years referred to a London teaching hospital for knee radiographs over 12 months. Radiographs were identified as WB/non-WB. Subsequent repeat WB views performed in those that went on to have an orthopaedic consultation were also documented. A consultant musculoskeletal radiologist reported both images. A proforma containing a likert scale of severity for commonly reported abnormalities in knee osteoarthritis and criteria from the Kellgren and Lawrence scale was used for reporting. London NHS Trusts were surveyed to identify if protocols were in place for performing WB views. A total of 1,968 patients underwent knee radiographs, of which 1922 (97.7%) had initial non-WB radiographs. Of the 56 patients in this group that underwent required repeat WB radiographs, joint space narrowing was reported as more severe on WB versus non-WB radiographs (p = 0.035). Only 54% of departments routinely performed WB radiographs. Few patients (2.3%) referred by GPs have WB radiographs requested. Some of those referred for a specialist opinion required repeat WB views. Nearly half of London hospitals do not routinely perform WB radiographs. This represents a significant financial burden to the NHS, increased radiation exposure and wasted patient/clinician time. We propose that all GP requested knee radiographs be performed as WB unless otherwise stated.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-707) contains supplementary material, which is available to authorized users.

Highlights

Osteoarthritis represents a complex musculoskeletal disorder with multiple genetic, constitutional and biomechanical risk factors
2.9% (n = 56) of patients had an initial general practice (GP) requested non-WB radiograph, and subsequently had repeat WB radiographs performed at the request of the orthopaedic surgeon
In the absence of such a national policy existing, our study suggests that it would be prudent for doctors in all specialities to request all AP and lateral knee radiographs as weight bearing views, unless there is a history of trauma or the patient is not able to bear weight on the knee

Summary

Introduction

Osteoarthritis represents a complex musculoskeletal disorder with multiple genetic, constitutional and biomechanical risk factors. It represents the most common form of joint disease in the elderly and ranks amongst the top 5 causes of disability (Murray and Lopez 1997). Professor Briggs highlighted in his report ‘Getting it right first time’ that 15%-30% of GP consultations will be of a musculoskeletal nature (Briggs 2012). 80% of GPs were likely to request a radiograph if considering referral to an orthopaedic surgeon. The radiological report of the GP-requested knee radiograph is pivotal in determining whether onward specialist referral is undertaken. The radiology report is influenced by whether WB or non-WB views are taken (Brandt et al 1991)

Methods

Results

Discussion

Conclusion