Medial Joint Space Width Research Articles

Cancellous bone differences between knees with early, definite and advanced joint space loss; a comparative quantitative macroradiographic study

To quantify differences in bone structure in the proximal tibia of patients with mild, definite and advanced osteoarthritis (OA) compared to healthy reference tibiae. Patients with medial compartment OA (n=110; F=70), mean+/-SD age 61.0+/-10.2 years, and non-OA reference subjects (n = 27; F = 10) mean+/-SD age 36.3+/-11.4 years had 4x macroradiographs digitised by laser scanner. Computer measurement of minimum medial joint space width (JSW) subdivided available OA knees into those with early (JSW > 3 mm, n=70), definite (JSW </= 3 > 1.5 mm, n = 52) and advanced OA (JSW </= 1.5 mm, n = 60). Non-OA knees (n = 49) had JSW > 4.5 mm. Fractal Signature Analysis (FSA), a computerised image analysis technique, measured differences in cancellous bone structure between OA and non-OA tibiae at four regions of interest (ROIs). Compared to non-OA, FSA of vertical trabeculae increased significantly (P < 0.05) at most sizes (0.12-1.14 mm) in all OA subgroups and ROIs, with greatest increase occurring in the medial diseased compartment. Compared to early OA, FSA of vertical trabeculae increased significantly (P<0.05) at most sizes (0.36-1.14 mm) in subchondral and subarticular ROIs in definite and advanced OA. Compared to non-OA, FSA of horizontal trabeculae increased significantly (P < 0.05) at some small sizes in all ROIs and OA subgroups, and decreased significantly (P<0.05) at large sized horizontal trabeculae (0.60-1.14 mm) in the medial subarticular region in advanced OA. The increase in FSA (consistent with increased trabecular number associated with thinning and fenestration in regions of dense cancellous bone) of most vertical and some horizontal trabeculae confirms that cancellous bone within the proximal tibia of OA patients is osteoporotic.

Influence of the quality of tibial plateau alignment on the reproducibility of computer joint space measurement from Lyon schuss radiographic views of the knee in patients with knee osteoarthritis

Rationale The quality of medial tibial plateau (MT-Plateau) alignment is one of the key elements for accuracy and sensitivity to change of knee radiography in knee osteoarthritis (OA). Aim To evaluate the influence of the quality of the MT-Plateau alignment on the reproducibility of joint space width (JSW) measurement in knee radiographs. Methods One hundred and twenty-seven knee radiographs (99 OA), performed using a standardized radiographic procedure (Lyon schuss (LS) view). • Evaluation of the quality of MT-Plateau alignment. • Computerized measurement of the JSW, twice, 1-month apart, using a semi-automated and an automated method of measurement. • Assessment of the reproducibility of repeated measurements: calculation of intra-observer coefficient of correlation, smallest detectable difference (SDD) and coefficient of variation (CV). Results MT-Plateau alignment was satisfactory in 99 radiographs (77.9%). Reproducibility was excellent in both satisfactory and non-satisfactory radiographs, irrespective of the method of measurement used. The automated measurement was more reproducible than the semi-automated one (CV 1.15% and 3.23%). SDD and CV were better in satisfactory than in non-satisfactory MT-Plateau aligned radiographs. Conclusion These results confirm that computer measurement of the medial tibio-femoral JSW, from LS digitized radiographs, is highly reproducible, irrespective of the quality of the radiograph. However, the quality of the MT-Plateau alignment influences the reproducibility of JSW measurement. The automated measurement was more reproducible than the semi-automated one.

Intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo

Objective: To investigate the efficacy and tolerability of a 3-month duration, twice a-year, intermittent treatment with oral chondroitin sulfate (CS) in knee osteoarthritis (OA) patients. Design: A total of 120 patients with symptomatic knee OA were randomized into two groups receiving either 800 mg CS or placebo (PBO) per day for two periods of 3 months during 1 year. Primary efficacy outcome was Lequesne’s algo-functional index (AFI); secondary outcome parameters included VAS, walking time, global judgment, and paracetamol consumption. Radiological progression was assessed by automatic measurement of medial femoro-tibial joint space width on weight-bearing X-rays of both knees. Clinical and biological tolerability was assessed. Results: One hundred and ten of 120 patients were included in the ITT analysis. AFI decreased significantly by 36% in the CS group after 1 year as compared to 23% in the PBO group. Similar results were found for the secondary outcomes parameters. Radiological progression at month 12 showed significantly decreased joint space width in the PBO group with no change in the CS group. Tolerability was good with only minor adverse events identically observed in both groups. Conclusion: This study provides evidences that oral CS decreased pain and improved knee function. The 3-month intermittent administration of 800 mg/day of oral CS twice a year does support the prolonged effect known with symptom-modifying agents for OA. The inhibitory effect of CS on the radiological progression of the medial femoro-tibial joint space narrowing could suggest further evidence of its structure-modifying properties in knee OA.

Obesity Related Measurements and Joint Space Width in Patients with Knee Osteoarthritis

BackgroundThe aim of this study is to analyze the relationship between body mass index and obesity related measurements and tibiofemoral joint space which have been the principal method of radiographic evaluation in progression and therapeutic trials of knee osteoarthritis.MethodsFifty-five female patients with the diagnosis of osteoarthritis in knees according to the criteria of American College of Rheumatology in knees were included in the study. The mean age of patients was 57,42+/-8,60(SD) years with a range of 42-77. Medial and lateral compartment joint space widths were measured on antero-posterior knee radiography. Body mass index, triceps, biceps, subscapular and suprailiac skinfold thickness, waist and hip circumference were measured. Body composition was determined by dual energy X-ray absorpsiometry (DEXA) (Norland XR 46) and total lean mass (g), total fat mass (g), trunk lean mass, trunk fat mass, abdomen lean mass, abdomen fat mass measurements were recorded.ResultsPatients with body mass index>30 were accepted as obese patients. According to these criteria 33 of the 55 patients were obese. Tibial medial compartment and tibial lateral compartment measurements of obese patients were significantly lower than nonobese patients (p=0,000, p=0,003 respectively). Body mass index was correlated with total lean mass, total fat mass, trunk fat mass, abdominal fat mass, leg fat mass. Tibial medial compartment and tibial lateral compartment space measurements were negatively correlated with body mass index. Conclusion: Our results revealed significant difference in both medial and lateral joint spaces of obese and nonobese patients with knee osteoarthritis. Medial and lateral joint spaces of obese patients were narrower than nonobese osteoarthritis patients. The more body mass index had the patients the narrower joint space they had displayed. However body composition analysis and obesity related measurements did not show additional correlation with tibial compartment measurement.

Influence of medial meniscectomy on tibiofemoral joint space width

Objective: The aim of this study was to evaluate the influence of partial medial meniscectomy on tibiofemoral joint space width (JSW). Design: Thirty-seven patients (mean age: 51 years), suffering from medial meniscal lesions, (post-traumatic ( n=22) or degenerative ( n=15)), and requiring arthroscopic partial meniscectomy, were enrolled in a prospective, controlled study. Bilateral weight-bearing radiographs in extended and flexed position were performed in the same Radiology Unit just before and 2 days after meniscectomy. During arthroscopy, the extent of meniscectomy was evaluated in percentage and medial chondropathy was quantified using the Société Française d'Arthroscopie (SFA) scoring system (SFA score: 0–100). Medial chondropathy was absent or mild (mean SFA score: 8±13). Meniscectomy removed an average of 61% of the posterior third of the medial meniscus, 51% of the middle third and 22% of the anterior third. Radiographs, before and after meniscectomy, were read singly and were analyzed by a single reader unaware of patient identity and date of radiographs. Medial JSW was measured at the narrowest point of the medial compartment using a 0.1 mm graduated magnifying glass. Results: Comparison of JSW before and after meniscectomy did not show any statistically significant difference (mm): 0.01±0.43 ( p=0.83) and −0.05±0.56 ( p=0.66) in the extended and flexed views, respectively. Conclusion: This preliminary study suggests that partial medial meniscectomy does not influence tibiofemoral JSW on weight-bearing X-rays. Consequently, joint space narrowing appearing after partial meniscectomy should lead to seeking postmeniscectomy cartilage degradation rather than being attributed to removal of the meniscus.

Arthroscopic evaluation of potential structure-modifying drug in osteoarthritis of the knee: A multicenter, randomized, double-blind comparison of tenidap sodium vs piroxicam

Objective: To test the hypothesis that tenidap has a structure-modifying effect in human knee osteoarthritis. Design: Study: multicenter, prospective, randomized, double blind, 1 year duration. Patients: primary painful knee osteoarthritis (ACR criteria) of the medial tibiofemoral compartment, medial joint space width ≥2 mm, at least 10% of one cartilage surface of the medial compartment affected by superficial fibrillation or worse at baseline arthroscopy. Study medication: once daily dosage of either tenidap 40 mg, tenidap 120 mg or piroxicam 20 mg. Study endpoints: bilateral extended weight-bearing X-rays and knee arthroscopy under local anaesthesia were done at entry and after 1 year. Joint space width was measured in millimeters at the narrowest point of the medial compartment. Chondropathy was scored by using reader's overall assessment (VAS score, 100 mm) and Société Française d'Arthroscopie (SFA) score (0–100). Results: Patients (665) were randomized and 494 completed the study. After 1 year, intra-group radiological changes and radiological difference between both tenidap groups and the piroxicam group did not reach statistical significance. The intra-group arthroscopic deterioration of chondropathy was low, but statistically significant in the three study groups. However, there was no statistically significant difference between both tenidap groups and the piroxicam group. Conclusions: This study failed to demonstrate any difference between the treatment arms with regard to the structural progression of medial knee osteoarthritis as measured by radiography and arthroscopy. Arthroscopy did, however, appears to be more sensitive in detecting disease progression than the weight-bearing radiographs with fully extended knees. This study shows that it is possible to complete a large international trial using arthroscopy as an outcome measure of articular cartilage.

No loss of cartilage volume over three years in patients with knee osteoarthritis as assessed by magnetic resonance imaging

Objective Magnetic resonance imaging (MRI) has the potential to provide accurate quantification of structural changes in joint disease, with sensitivity to change, as it can provide direct visualization of the cartilage and bone. In this study, we investigated whether knee cartilage volume, as assessed by MRI, is sensitive to change over time in patients with osteoarthritis (OA).Design Sixteen patient volunteers (10 male, six female) with established OA of the knee were entered into the study and demographic data recorded. At baseline, 12 months and 37±2 months, patients underwent simple measures of disease severity, as well as extended weight-bearing AP knee X-rays. In addition the patient's index knee was imaged using MR at 1.0T using a 3-D spoiled gradient–echo sequence with fat-suppression, repetition time 50ms, echo time 11ms, flip-angle 40°, sagittal slice thickness 1.56mm and in-plane pixel resolution 0.55mm. Manual image segmentation was performed on all knee cartilage compartments and the respective cartilage volumes determined.Results Eleven of the original patients recruited completed the 3-year study. Radiographic features indicated that the majority had a spectrum of well-established OA at entry. The average decrease in medial tibiofemoral joint space width was 0.21±0.37mm (mean±S.D.). Comparison of MR images at baseline and 37±2 months indicated little evidence of cartilage lesion shape or size change in any of the compartments. There was no significant MRI volume change in any of the knee cartilage compartments over the course of 1 year. The change in total knee cartilage volume, as measured by MRI, was a loss of only 1.6%, or 0.36±1.3ml (mean±S.D.), over the 3 years.Conclusions The failure to identify loss of cartilage volume over 3 years in this cohort of patients with established knee OA using MRI challenges the face validity of this endpoint to assess structural changes in OA. Copyright 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved.

PLAIN RADIOGRAPHY AS AN OUTCOME MEASURE IN CLINICAL TRIALS INVOLVING PATIENTS WITH KNEE OSTEOARTHRITIS

The identification of pharmacologic agents that inhibit matrix metalloproteinase activity and may serve as effective disease-modifying osteoarthritis drugs (DMOADs) in humans has led to interest in the ability of plain radiographic methods to detect early cartilage damage and assess progressive cartilage changes of knee osteoarthritis (OA). Conventional knee radiography lacks sufficient standardization of key elements of the radioanatomic positioning of the knee to avoid significant, probably insurmountable, error variation in the measurement of tibiofemoral joint space width (JSW), the surrogate for the thickness of articular cartilage in radiographic images. Recently, several protocols for the use of fluoroscopy to standardize the radioanatomic position of the knee in a plain radiograph have been shown to afford notably more precise measurement of medial tibiofemoral JSW than can be derived from unstandardized, conventional techniques. A field test of one of these protocols suggests that DMOAD trials with respect to sample size or duration of treatment necessary to detect true OA progression and demonstrate a drug effect may be more feasible.

Relationship Between Lateral Subluxation and Widening of Medial Joint Space in Legg-Calvé-Perthes Disease

Fifty-five patients (61 affected hips and 49 unaffected hips) with Perthes disease were reviewed to evaluate the relationship between widening of medial joint space and lateral subluxation of the femoral head in radiographs. The components of the medial joint space were evaluated by using T1, T2, proton, and Gd-enhanced T1WI magnetic resonance images (MRI). The widened medial joint space in radiographs was filled with overgrown cartilage at the initial stage (27 hips) in MRI, with both overgrown cartilage and widened true medial joint space at the fragmentation stage (23 hips) and widened true medial joint space at the healing stage (11 hips). Between affected hips and unaffected hips, the mean difference of medial joint space in radiographs between hips at the initial stage and at the fragmentation stage was 2 and 4.5 mm, respectively; the mean difference in percentage of lack of coverage of the femoral head between hips at the initial stage and at the fragmentation stage was 3 and 15%, respectively. During the healing stage, widening of the medial joint space decreased or normalized because of ossification of overgrown cartilage despite the existence of lateral subluxation because of coxa magna. We concluded that widening of the medial joint space may be used as an index of lateral subluxation at only the fragmentation stage in Perthes disease.

Relationship Between Lateral Subluxation and Widening of Medial Joint Space in Legg-Calvé-Perthes Disease

Fifty-five patients (61 affected hips and 49 unaffected hips) with Perthes disease were reviewed to evaluate the relationship between widening of medial joint space and lateral subluxation of the femoral head in radiographs. The components of the medial joint space were evaluated by using T1, T2, proton, and Gd-enhanced T1WI magnetic resonance images (MRI). The widened medial joint space in radiographs was filled with overgrown cartilage at the initial stage (27 hips) in MRI, with both overgrown cartilage and widened true medial joint space at the fragmentation stage (23 hips) and widened true medial joint space at the healing stage (11 hips). Between affected hips and unaffected hips, the mean difference of medial joint space in radiographs between hips at the initial stage and at the fragmentation stage was 2 and 4.5 mm, respectively; the mean difference in percentage of lack of coverage of the femoral head between hips at the initial stage and at the fragmentation stage was 3 and 15%, respectively. During the healing stage, widening of the medial joint space decreased or normalized because of ossification of overgrown cartilage despite the existence of lateral subluxation because of coxa magna. We concluded that widening of the medial joint space may be used as an index of lateral subluxation at only the fragmentation stage in Perthes disease.

Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis.

The adduction moment at the knee during gait is the primary determinant of medial-to-lateral load distribution. If the adduction moment contributes to progression of osteoarthritis (OA), then patients with advanced medial tibiofemoral OA should have higher adduction moments. The present study was undertaken to investigate the hypothesis that the adduction moment normalized for weight and height is associated with medial tibiofemoral OA disease severity after controlling for age, sex, and pain level, and to examine the correlation of serum hyaluronan (HA) level with disease severity and with the adduction moment in a subset of patients. Fifty-four patients with medial tibiofemoral OA underwent gait analysis and radiographic evaluation. Disease severity was assessed using the Kellgren-Lawrence (K-L) grade and medial joint space width. In a subset of 23 patients with available sera, HA was quantified by sandwich enzyme-linked immunosorbent assay. Pearson correlations, a random effects model, and multivariate regression models were used. The adduction moment correlated with the K-L grade in the left and right knees (r = 0.68 and r = 0.60, respectively), and with joint space width in the left and right knees (r = -0.45 and r = -0.47, respectively). The relationship persisted after controlling for age, sex, and severity of pain. The partial correlation between K-L grade and adduction moment was 0.71 in the left knees and 0.61 in the right knees. For every 1.0-unit increase in adduction moment, there was a 0.63-mm decrease in joint space width. In the subset of patients in whom serum HA levels were measured, HA levels correlated with medial joint space width (r = -0.55), but not with the adduction moment. There is a significant relationship between the adduction moment and OA disease severity. Serum HA levels correlate with joint space width but not with the adduction moment. Longitudinal studies will be necessary to determine the contribution of the adduction moment, and its contribution in conjunction with metabolic markers, to progression of medial tibiofemoral OA.

Accuracy and precision of joint space width measurements in standard and macroradiographs of osteoarthritic knees.

To improve the reproducibility and accuracy of joint space width (JSW) measurement as an assessment of cartilage loss in patients with osteoarthritis (OA) of the knee by determining how precision and accuracy of JSW measurement were altered by a computerised method of measurement, correction for radiographic magnification, radiography of the knee in the standing semiflexed view, and high definition macroradiography of the knee in the semiflexed view--taking JSW measurements from standard radiographs of OA knees in the extended view as the standard for comparison. Twenty five OA and 10 nonarthritic knees were radiographed in the extended view and minimum JSW was measured manually. Conventional and x5 macroradiographs were taken in the semiflexed view. All radiographs were taken twice on the same day and repeated two weeks later. Automated computerised measurement of minimum JSW was obtained from digitally stored images of all radiographs. For medial compartment JSW measurements, computerised was more accurate than manual, correction for radiographic magnification improved precision and accuracy, measurements in the semiflexed view were more precise and accurate, and macroradiography increased measurement precision. For the lateral compartment JSW measurements, correction for radiographic magnification improved precision and accuracy, and the semiflexed view improved precision only. Protocols defining radiographic and mensural procedures are essential for quality control of knee radiography in the semiflexed view to permit accurate and reproducible measurement of JSW. Macroradiography provides greater precision of JSW measurement.

Early failure of silicone radial head implants in the rheumatoid elbow: A complication of silicone radial head implant arthroplasty

Three cases of early recurrent synovitis of the rheumatoid elbow following silicone radial head implant arthroplasty are presented. All three patients underwent synovectomy with silicone radial head implant for pain and loss of function due to rheumatoid synovitis. All three implants failed within 4–9 months after surgery. This failure was associated with radiographic medial joint space widening. At reexploration, recurrent synovitis with hemosiderin pigmentation was noted. Patterns of prosthetic failure included fracture, fraying, and compressive deformation or rotary wear (“motar and pestle”) of the silicone radial head; a prosthetic stem fracture was also present. Histologic examination of the synovium revealed evidence of silicone-induced synovitis; particulate, refractile silicone debris was associated with inflammatory and foreign body giant cells. The presence of rheumatoid destruction of the joint surface may have accelerated this process and may be a relative contraindiction to silicone radial head implant arthroplasty.

ＯＡしつに対する足底そう板の使用経験 重回帰分析による検討

The shoe insert for the treatment of the osteoarthritic knee was made on an experimental basis. Its result was good and reduction of pain was 74.3%. Moreover, the roentgenograms, the functional evaluation of the knee joint and grade of satisfaction in patient were employed as parameter, and the multiple regression analysis was performed using a computer, and then, the range of the indication was determined.—Our results showed that the medial joint space was a most important factor followed by the score of functional evaluation of the knee joint, and varus deformity was not an expectant factor.The indication of the shoe insert was concluded as follows.1. Width of medial joint space is over 2mm, 2. Score of functional evaluation of the knee is over 50 point, 3. OA change of knee joint is not severe.

変形性しつ関節症に対する足底装具による治療経験

One hundred and seven patients (145 knees) suffering from osteoarthritis of the knee were treated by the shoe-brace with lateral wedge.In 97 knees that difference of the width of medial joint space between at nonbearing and at bearing time were within 2mm, 48 knees (49.4%) obtained clinical efect.In 48 knees that radiological change were over 2mm, only 6 cases (12.5%) obtained clinical effect and 9 knees of them were treated by high-tibial osteotomy.The shoe-brace with lateral wedge to osteorthritis of the knee is considered to be effective for the knee that radiological change is within 2mm.

161Dy isomer shifts in dysprosium compounds

Objective Magnetic resonance imaging (MRI) has the potential to provide accurate quantification of structural changes in joint disease, with sensitivity to change, as it can provide direct visualization of the cartilage and bone. In this study, we investigated whether knee cartilage volume, as assessed by MRI, is sensitive to change over time in patients with osteoarthritis (OA).Design Sixteen patient volunteers (10 male, six female) with established OA of the knee were entered into the study and demographic data recorded. At baseline, 12 months and 37±2 months, patients underwent simple measures of disease severity, as well as extended weight-bearing AP knee X-rays. In addition the patient's index knee was imaged using MR at 1.0T using a 3-D spoiled gradient–echo sequence with fat-suppression, repetition time 50 ms, echo time 11 ms, flip-angle 40°, sagittal slice thickness 1.56 mm and in-plane pixel resolution 0.55 mm. Manual image segmentation was performed on all knee cartilage compartments and the respective cartilage volumes determined.Results Eleven of the original patients recruited completed the 3-year study. Radiographic features indicated that the majority had a spectrum of well-established OA at entry. The average decrease in medial tibiofemoral joint space width was 0.21±0.37mm (mean±S.D.). Comparison of MR images at baseline and 37±2 months indicated little evidence of cartilage lesion shape or size change in any of the compartments. There was no significant MRI volume change in any of the knee cartilage compartments over the course of 1 year. The change in total knee cartilage volume, as measured by MRI, was a loss of only 1.6%, or 0.36±1.3 ml (mean±S.D.), over the 3 years.Conclusions The failure to identify loss of cartilage volume over 3 years in this cohort of patients with established knee OA using MRI challenges the face validity of this endpoint to assess structural changes in OA. Copyright 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved.