Radiographic Joint Space Width Research Articles

Estimation of radiographic joint space of the trapeziometacarpal joint with computed tomographic validation.

Joint space width (JSW) is a common metric used to evaluate joint structure on plain radiographs. For the hand, quantitative techniques are available for evaluation of the JSW of finger joints; however, such techniques have been difficult to establish for the trapeziometacarpal (TMC) joint. This study aimed to develop a validated method for measuring the radiographic joint space of the healthy TMC joint. Computed tomographic scans were taken of 15 cadaveric hands. The location of a JSW analysis region on the articular surface of the first metacarpal was established in 3D space and standardized in a 2D projection. The standardized region was applied to simulated radiographic images. A correction factor was defined as the ratio of the CT-based and radiograph-based joint space measurements. Leave-one-out validation was used to correct the radiograph-based measurements. A t-test was used to evaluate the difference between CT-based and corrected radiograph-based measurements (). The CT-based and radiograph-based measurements of JSW were and , respectively. The correction factor for radiograph-based joint space was . Before correction, the difference between the CT-based and radiograph-based joint space was 1.43mm [95% CI: ; ]. After correction, the difference was [95% CI: ; ]. Corrected measurements of radiographic TMC JSW agreed well with CT-measured JSW. With in-vivo validation, the developed methodology has potential for automated and accurate radiographic measurement of TMC JSW.

Radiographic joint space width in individuals with hand osteoarthritis: Are their “healthy” joints really healthy?

We aimed to investigate the systemic nature of hand osteoarthritis (OA). We hypothesized that people who suffer from hand OA will display narrower radiographic joint space width (JSW) - not only in joints with apparent radiographic OA but also in their unaffected "healthy" joints. We examined 3394 participants from the Osteoarthritis Initiative (OAI) with available dominant hand radiographs at baseline. Cases were defined as having interphalangeal OA (IPOA) based on a Kellgren and Lawrence (KL) score of ≥2 in two or more finger joints, whereas controls did not have IPOA. We used custom software to make JSW measurements of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints in fingers 2-5 per hand. In joint-level analyses, we included only KL score = 0, allowing us to compare all joints without IPOA in cases and controls. We used generalized estimating equation (GEE) models to compare JSW between both groups, adjusted for age, gender, metacarpal length, and joint type. Finger joints without radiographic OA had significantly narrower JSW in the IPOA group compared to finger joints in the control group (p<0.001). The differences were significant across all joint types and for both total JSW measurements as well as for central and lateral sub-regions within each joint group (p<0.001). Unaffected finger joints in people with IPOA had narrower joint space than joints of healthy controls. This implies a systemic nature of hand OA, in which people may have a predisposition for general cartilage deterioration.

Assessing lateral femoral condyle cartilage prior to medial UKA: MRI vs. Valgus stress radiograph

BackgroundThe cartilage quality of the lateral compartment needs to be clarified prior to medial unicompartmental knee arthroplasty (UKA). Valgus stress radiograph has been recommended as the preferred tool. Some studies also show that magnetic resonance imaging (MRI) has a higher diagnostic value. So, we conducted this study to compare whether valgus stress radiographic lateral joint space width (LJSW) and MRI grading can accurately reflect cartilage quality and its screening value for UKA-suitable patients.MethodsOne hundred and thirty eight knees proposed for UKA were enrolled prospectively. Valgus stress radiograph was taken to measure LJSW. LJSW > 4 mm was considered normal and suitable for UKA. For weight-bearing area cartilage of lateral femoral condyle, Recht grade was assessed by MRI preoperatively. Recht grades ≤ 2 were treated as non-high-grade injuries while Recht grades > 2 were treated as high-grade injuries. Outerbridge grade was the gold standard and was assessed intraoperatively. Patients with Outerbridge grades 0–2 (non-high-grade injuries) underwent UKA, and patients with Outerbridge grades 3–4 (high-grade injuries) underwent total knee arthroplasty (TKA). The diagnostic parameters of valgus stress radiograph and MRI for the selection of UKA candidates were calculated, and receiver operating characteristic curves were drawn. P < 0.05 was considered significant.ResultsOf 138 knees, 120 underwent UKAs, and 18 underwent TKAs. In terms of selecting UKA candidates, the sensitivity was close between MRI (95.0%) and valgus stress radiograph (96.7%), and the specificity, accuracy, positive predictive value and negative predictive value of MRI (94.4%, 94.9%, 99.1%, 73.9%, respectively) were higher than that of valgus stress radiograph (5.9%, 85.5%, 88.0%, 20.0%, respectively). The difference in area under the curve (AUC) between MRI (0.950) and LJSW (0.602) was significant (P = 0.001).ConclusionCompared with valgus stress radiograph, MRI has excellent evaluation value in diagnosing lateral weight-bearing cartilage injuries and can be used as a reliable tool for selecting suitable UKA patients.

Joint distraction using a purpose-built device for knee osteoarthritis: a prospective 2-year follow-up

ObjectiveKnee distraction treatment for end-stage osteoarthritis successfully postpones arthroplasty for years. Studies performed thus far used general intended use, patient-personalised or custom-made devices. In this study, for the first time,...

Evaluation of S201086/GLPG1972, an ADAMTS-5 inhibitor, for the treatment of knee osteoarthritis in ROCCELLA: a phase 2 randomized clinical trial

To evaluate the efficacy and safety of the anti-catabolic ADAMTS-5 inhibitor S201086/GLPG1972 for the treatment of symptomatic knee osteoarthritis. ROCCELLA (NCT03595618) was a randomized, double-blind, placebo-controlled, dose-ranging, phase 2 trial in adults (aged 40-75 years) with knee osteoarthritis. Participants had moderate-to-severe pain in the target knee, Kellgren-Lawrence grade 2 or 3 and Osteoarthritis Research Society International joint space narrowing (grade 1 or 2). Participants were randomized 1:1:1:1 to once-daily oral S201086/GLPG1972 75, 150 or 300mg, or placebo for 52 weeks. The primary endpoint was change from baseline to week 52 in central medial femorotibial compartment (cMFTC) cartilage thickness assessed quantitatively by magnetic resonance imaging. Secondary endpoints included change from baseline to week 52 in radiographic joint space width, Western Ontario and McMaster Universities Osteoarthritis Index total and subscores, and pain (visual analogue scale). Treatment-emergent adverse events (TEAEs) were also recorded. Overall, 932 participants were enrolled. No significant differences in cMFTC cartilage loss were observed between placebo and S201086/GLPG1972 therapeutic groups: placebo vs 75mg, P=0.165; vs 150mg, P=0.939; vs 300mg, P=0.682. No significant differences in any of the secondary endpoints were observed between placebo and treatment groups. Similar proportions of participants across treatment groups experienced TEAEs. Despite enrolment of participants who experienced substantial cartilage loss over 52 weeks, during the same time period, S201086/GLPG1972 did not significantly reduce rates of cartilage loss or modify symptoms in adults with symptomatic knee osteoarthritis.

Exploring the differences between radiographic joint space width and MRI cartilage thickness changes using data from the IMI-APPROACH cohort.

Longitudinal weight-bearing radiographic joint space width (JSW) and non-weight-bearing MRI-based cartilage thickness changes often show weak correlations. The current objective was to investigate these correlations, and to explore the influence of different factors that could contribute to longitudinal differences between the two methods. The current study included 178 participants with medial osteoarthritis (OA) out of the 297 knee OA participants enrolled in the IMI-APPROACH cohort. Changes over 2years in medial JSW (ΔJSWmed), minimum JSW (ΔJSWmin), and medial femorotibial cartilage thickness (ΔMFTC) were assessed using linear regression, using measurements from radiographs and MRI acquired at baseline, 6months, and 1 and 2years. Pearson R correlations were calculated. The influence of cartilage quality (T2 mapping), meniscal extrusion (MOAKS scoring), potential pain-induced unloading (difference in knee-specific pain scores), and increased loading (BMI) on the correlations was analyzed by dividing participants in groups based on each factor separately, and comparing correlations (slope and strength) between groups using linear regression models. Correlations between ΔMFTC and ΔJSWmed and ΔJSWmin were statistically significant (p < 0.004) but weak (R < 0.35). Correlations were significantly different between groups based on cartilage quality and on meniscal extrusion: only patients with the lowest T2 values and with meniscal extrusion showed significant moderate correlations. Pain-induced unloading or BMI-induced loading did not influence correlations. While the amount of loading does not seem to make a difference, weight-bearing radiographic JSW changes are a better reflection of non-weight-bearing MRI cartilage thickness changes in knees with higher quality cartilage and with meniscal extrusion.

Improved responsiveness to change in joint space width over 24-month follow-up: comparison of 3D JSW on weight-bearing CT vs 2D JSW on radiographs in the MOST study

Radiographic joint space width (JSW) has been a standard for measuring knee osteoarthritis (OA) structural change. Limitations in the responsiveness of this approach might be overcome by instead measuring 3D JSW on weight-bearing CT (WBCT). This study compared the responsiveness of 3D JSW measurements using WBCT with the responsiveness of radiographic 2D JSW. Standing, fixed-flexion knee radiographs (XR) and WBCT were acquired ancillary to the 144- and 168-month Multicenter Osteoarthritis Study visits. Tibiofemoral JSW was measured on both XR and WBCT. Responsiveness to change was defined by the standardized response mean (SRM) for change in JSW (1) at predetermined mediolateral locations (JSWx) on both modalities and (2) in the following subregions measured on WBCT images: central medial and lateral femur (CMF/CLF) and tibia (CMT/CLT), and anterior and posterior tibia (AMT/ALT, PMT/MLT). Baseline and 24-month follow-up JSWx measurements were completed for 265 participants (58.1% women). Responsiveness of 3D JSWx for medial tibiofemoral compartment on coronal WBCT (SRM range:-0.18,-0.24) exceeded that for 2D JSWx (-0.10,-0.16). Responsiveness of 3D JSW subregional mean (-0.06,-0.36) and maximal (-1.14,-1.75) CMF and CMT and maximal CLF/CLT 3D JSW changes were statistically significantly greater in comparison with respective medial and lateral 2D JSWx (P≤0.002). Subregional 3D JSW on WBCT is substantially more responsive to 24-month changes in tibiofemoral joint structure compared to radiographic measurements. Use of subregional 3D JSW on WBCT could enable improved detection of OA structural progression over a 24-month duration in comparison with measurements made on XR.

Association of Superficial Cartilage Transverse Relaxation Time With Osteoarthritis Disease Progression: Data From the Foundation for the National Institutes of Health Biomarker Study of the Osteoarthritis Initiative.

To study whether layer-specific cartilage transverse relaxation time (T2) and/or longitudinal change is associated with clinically relevant knee osteoarthritis (OA) disease progression. The Foundation for the National Institutes of Health Biomarker Consortium was a nested case-control study on 600 knees from 600 Osteoarthritis Initiative participants. Progressor knees had both medial tibiofemoral radiographic joint space width (JSW) loss (≥0.7 mm) and a persistent increase in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score (≥9 on a 0-100 scale) at 24-48 months from baseline (n=194). Multiecho spin-echo (MESE) magnetic resonance images (MRIs) for cartilage T2 analysis had been acquired in the right knees only (97 progressor knees). These were compared to 104 control knees without JSW or pain progression. Fifty-three knees had JSW progression, and 57 pain progression only. Cartilage thickness segmentations obtained from double-echo steady-state MRI were matched to MESE MRI to extract superficial and deep femorotibial cartilage T2. Superficial medial femorotibial compartment (MFTC) T2 at baseline was the primary, and change in deep MFTC T2 between baseline and 12 months was the secondary analytic outcome of this post hoc exploratory study. Baseline superficial MFTC T2 was significantly elevated in progressor knees (adjusted mean 47.2 msec [95% confidence interval (95% CI) 46.5, 48.0]) and JSW progression only knees (adjusted mean 47.3 msec [95% CI 46.3, 48.3]), respectively, versus non-progressor knees (45.8 msec [95% CI 45.0, 46.5]) after adjustment for age, sex, body mass index, WOMAC pain score, and medial joint space narrowing grade (analysis of covariance). Change in T2 was not significantly associated with case status. Baseline superficial, but not deep, medial cartilage T2 is associated with clinically relevant disease progression in knee OA.

Effectiveness of vitamin D supplementation on knee osteoarthritis - A target trial emulation study using data from the Osteoarthritis Initiative cohort

To assess the real-world effectiveness of vitamin D supplementation in patients with knee osteoarthritis (KOA) by replicating a randomized controlled trial (RCT) design in an observational study. This study emulated a target trial using data from the Osteoarthritis Initiative (OAI). Eligible participants were ≥45 years, had symptomatic KOA and did not take vitamin D supplements in the past 30 days. A participant can enter the trial more than once. Participants were included in vitamin D group if they took ≥1,000 IU/day for ≥4 days/week in the past 30 days at the first follow-up visit after baseline. The control group did not use vitamin D in the past 30 days. Optimal propensity score matching at 1:1 ratio was performed. The primary outcome was change in knee pain 2years after baseline measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included WOMAC physical function and quantitative joint space width (JSW). Standardized mean difference (SMD) was used to compare the findings with previous RCTs. A total of 236 person-trials in the vitamin D group were pair-matched with a control. Compared to the control group, vitamin D supplementation did not reach significant changes in WOMAC pain (SMD=-0.04, 95%CI [-0.21, 0.13]), physical function and radiographic JSW over 2 years. The SMDs were consistent with the effect sizes reported in previous RCTs. Target trial emulation in the OAI cohort demonstrated findings close to published RCTs. This supports the future use of target trial emulation in evaluating other systemic therapies for KOA.

Detection of Differences in Longitudinal Cartilage Thickness Loss Using a Deep-Learning Automated Segmentation Algorithm: Data From the Foundation for the National Institutes of Health Biomarkers Study of the Osteoarthritis Initiative.

ObjectiveTo study the longitudinal performance of fully automated cartilage segmentation in knees with radiographic osteoarthritis (OA), we evaluated the sensitivity to change in progressor knees from the Foundation for the National Institutes of Health OA Biomarkers Consortium between the automated and previously reported manual expert segmentation, and we determined whether differences in progression rates between predefined cohorts can be detected by the fully automated approach.MethodsThe OA Initiative Biomarker Consortium was a nested case–control study. Progressor knees had both medial tibiofemoral radiographic joint space width loss (≥0.7 mm) and a persistent increase in Western Ontario and McMaster Universities Osteoarthritis Index pain scores (≥9 on a 0–100 scale) after 2 years from baseline (n = 194), whereas non‐progressor knees did not have either of both (n = 200). Deep‐learning automated algorithms trained on radiographic OA knees or knees of a healthy reference cohort (HRC) were used to automatically segment medial femorotibial compartment (MFTC) and lateral femorotibial cartilage on baseline and 2‐year follow‐up magnetic resonance imaging. Findings were compared with previously published manual expert segmentation.ResultsThe mean ± SD MFTC cartilage loss in the progressor cohort was –181 ± 245 μm by manual segmentation (standardized response mean [SRM] –0.74), –144 ± 200 μm by the radiographic OA–based model (SRM –0.72), and –69 ± 231 μm by HRC‐based model segmentation (SRM –0.30). Cohen's d for rates of progression between progressor versus the non‐progressor cohort was –0.84 (P < 0.001) for manual, –0.68 (P < 0.001) for the automated radiographic OA model, and –0.14 (P = 0.18) for automated HRC model segmentation.ConclusionA fully automated deep‐learning segmentation approach not only displays similar sensitivity to change of longitudinal cartilage thickness loss in knee OA as did manual expert segmentation but also effectively differentiates longitudinal rates of loss of cartilage thickness between cohorts with different progression profiles.

Patients with advanced lateral osteoarthritis can return to sports and work after distraction arthroplasty plus lateral meniscal allograft transplantation combined with cartilage repair.

This study aimed to report return to sports (RTS) and return to work (RTW) outcomes after distraction arthroplasty (DA) plus lateral meniscal allograft transplantation (MAT) combined with cartilage repair in active patients with advanced osteoarthritis. It was hypothesised that DA combined with lateral MAT would improve clinical and radiological outcomes and enable RTS and RTW for most patients. In total, 21 patients with advanced osteoarthritis (moderate to severe joint space narrowing at lateral edge on Rosenberg view and large cartilage defect of lateral femoral condyle) who underwent concomitant DA and MAT were retrospectively reviewed. Clinical outcomes were assessed using subjective knee scores [Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity scale (TAS)] and functional tests (isokinetic extensor muscle strength test, single-leg vertical jump test, and single-leg hop for distance test). The rates of RTS, RTW, and satisfaction were evaluated. Radiological outcomes were assessed using magnetic resonance imaging (MRI) and X-ray (Rosenberg view). The mean age at surgery and mean follow-up duration were 37.2 ± 5.9years and 37.1 ± 5.4months, respectively. All improvements in subjective scores were statistically significant (p < 0.001). The Lysholm score improved from 58.3 ± 8.1 to 84.3 ± 8.2, the IKDC subjective score from 53.9 ± 10.4 to 78.0 ± 7.7, and the TAS from 4.0 ± 0.5 to 5.1 ± 0.8. The limb symmetry index (LSI) (%) of the extensor peak torque at an angular velocity of 60°/s improved from 67.3 ± 19.2 to 88.4 ± 20.3% (p = 0.001). The LSI of the single-leg vertical jump test and single-leg hop for distance test improved from 62.8 ± 21.3 to 87.7 ± 19.5% and from 63.9 ± 20.8 to 85.5 ± 18.1%, respectively (all, p < 0.001). All patients were able to return to any sports activity and work. However, 67% and 90.5% returned to their defined or desired level of sports activity and occupation intensity, respectively. Further, 76.2% were very satisfied or somewhat satisfied with the outcome at the last follow-up. The JSW increased by 0.8 ± 0.4 to 2.3 ± 0.6mm (p = 0.005). In more than 90% of patients, > 50% of cartilage lesion was covered. The mean graft extrusion was 2.6 ± 1.0mm. All patients who underwent distraction arthroplasty plus lateral MAT combined with cartilage repair returned to any sports and work at the last follow-up. Significant improvements in clinical outcomes and the radiographic joint space width were observed. However, the activity ability was somewhat reduced compared with the best preoperative level. This one-stage joint salvage treatment is a promising option for young and active patients with advanced OA who wish to return to high levels of sports activity and occupation intensity (≥ Tegner activity scale 4). III.

Associated Factors with the Severity of Hip Involvement in Spondyloarthritis and Efficacy of TNF α Inhibitors in these Patients.

Hip involvement in patients with spondyloarthritis is responsible for disability and functional impairment. Its treatment is not codified. Our study aimed to determine the associated factors with moderate and severe hip involvement in spondyloarthritis patients. It also aimed to assess the efficacy of tumour necrosis factor inhibitors (TNFi) on hip disease. We conducted a cross-sectional study, including 44 spondyloarthritis patients with hip involvement. Hip involvement was diagnosed based on radiographic findings. We assessed the following parameters: Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), patient global assessment (PGA), and Lequesne index. We compared these parameters and the mean radiographic joint space width between the time of the study to those right before the use of TNFi. Hip involvement was bilateral in 31 patients. The mean age was 44.56±12.21 years. There were 29 men. Severe and moderate involvement (BASRI-hip>3) was reported in 21 hips from 75 affected. These patients were older and had longer diagnosis delays than patients with BASRI- hip<3. They had a higher body mass index and more limited spine mobility (BASMI). Functional hip impairment assessed by the Lequesne index was higher in these patients. TNFi prescribed in 23 patients with hip involvement, led to an improvement in the Lequesne index (12.75 vs 7.5, p: 0.001) and PGA (7 vs 2, p: 0.001). However, the mean joint space width remained unchanged (3.8 vs 3.7mm, p: 0.532). Our study showed that higher body mass and Lequesne indexes are associated with moderate and severe hip involvement. TNFi may improve both the Lequesne index and PGA and stabilize the radiological findings.

Medial Tibial Osteophyte Width Strongly Reflects Medial Meniscus Extrusion Distance and Medial Joint Space Width Moderately Reflects Cartilage Thickness in Knee Radiographs.

BackgroundThe presence of medial tibial osteophytes on knee radiographs suggests cartilage wear, but may be associated with medial meniscus extrusion (MME). The joint space width of the medial compartment consists anatomically of cartilage and the medial meniscus, but which is most responsible for joint space narrowing remains unclear. Magnetic resonance imaging (MRI) reveals MME and cartilage thickness.PurposesTo determine which radiographic medial tibial osteophyte width correlates better with cartilage thickness or MME distance and which radiographic medial joint space width correlates better with cartilage thickness or MME distance.Study TypeCross‐sectional.PopulationTotal of 527 subjects, 253 females and 274 males, aged 30–79 years, included in the Kanagawa Knee Study.Field Strength/Sequence3 T/fat‐suppressed spoiled gradient echo and proton density weighted.AssessmentThe medial tibial osteophyte width and “the minimum joint space width at the medial compartment” (mJSW) were measured from plain radiographs. The cartilage region was automatically extracted from MRI data using software. The medial femoral and tibial cartilage regions were each divided into nine subregions, and the average thickness of the cartilage was determined in each region and subregion. MME was manually measured by two orthopedic surgeons using MRI coronal section images.Statistical TestsPearson's correlation coefficient and their comparison, with P < 0.05 considered statistically significant.ResultsThe absolute values of the correlation coefficients were 0.33 at maximum between osteophyte width and cartilage thickness and 0.76 between osteophyte width and MME; the value was significantly higher with MME than with cartilage thickness (P < 0.001). The absolute values of the correlation coefficients were 0.50 at maximum between mJSW and cartilage thickness and 0.16 between mJSW and MME; the value was significantly higher with cartilage thickness than with MME (P < 0.001).Data ConclusionThe medial tibial osteophyte width strongly reflected MME and the medial joint space width moderately reflected cartilage thickness.Level of Evidence3Technical Efficacy Stage3

Radiographic Measurements of Normal Knee Joint Space in Adults

Introduction: The knee joint is the space between the femoral and tibial condyles. The tibiofemoral articulations are separated by articular cartilages and menisci; with little contributions from cruciate ligaments. These are collectively seen on a radiograph as a radiolucent area between the bony tibial and femoral condyles. This study was conducted to measure the normal knee joint space in patients referred for X-Ray to the Department of Radiology of a tertiary care hospital.&#x0D; Methods: This descriptive cross-sectional study was performed from 1st January to 1st April 2021 in the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital (TUTH). A total of 157 patients were involved. The radiographic joint space width in the knee joint was measured in both medial and lateral compartments of bilateral knees in correlation with age and gender.&#x0D; Results: The mean right medial, left medial, right lateral, and left lateral spaces for females were 0.25±0.08 cm, 0.23±0.09 cm, 0.49±0.10 cm, and 0.49±0.29 cm respectively. Similarly, the mean right medial left medial, right lateral, and left lateral spaces for males were 0.26±0.07 cm, 0.10±0.09 cm, 0.18±0.09 cm, and 0.17±0.08 cm respectively. There was a strong positive correlation between both right and left joint spaces about age.&#x0D; Conclusion: The radiographic reference values for the joint space width were obtained, showing a positive correlation with age and no significant gender variations in bilateral knees.

India ink artifact on Dixon out-of-phase images can be used as a landmark to measure joint space width at MRI

PurposeThe purpose of this study was to test the feasibility of joint space width (JSW) measurement on Dixon MR images with the “India ink” artifact between cartilage and bone marrow as a landmark for the subchondral plate and to correlate it with radiographic JSW. Materials and methodsBoth hands of six volunteers (three women, three men; mean age, 36.7 ± 10.4 [SD] years) and 24 patients with early rheumatoid arthritis (16 women, 8 men; mean age, 45.7 ± 14.5 [SD] years) were imaged with MRI Dixon sequences and radiographs. Two radiologists (R1, R2) separately measured JSW in 11 joints per hand on all Dixon images in volunteers, on contrast-enhanced T1-weighted out-of-phase images in patients and on radiographs in both groups. Inter-technique, intra-observer and inter-observer agreements were assessed using intraclass correlation coefficient (ICC) and Bland Altman analysis. ResultsIn volunteers, agreement between JSW measurements on MRI and radiographs was the highest with T1-weighted Dixon out-of-phase images (mean ICC ranging from 0.69 to 0.76 for R1 and 0.65 to 0.74 for R2). In patients, median bias between JSW measurements at first and second readings was not statistically significantly different from 0 on T1-weighted Dixon out-of-phase images (mean bias of 0.00 and + 0.01 mm) and radiographs (mean bias of 0.00 and +0.01 mm). Median bias of the difference between measurements of R1 and R2 was statistically significantly different from 0 on T1-weighted Dixon out-of-phase images (mean bias of -0.11 and -0.09 mm; P < 0.039) and radiographs (mean bias of -0.24 and -0.20 mm; P < 0.035). ConclusionMeasurement of hand JSW on T1-weighted Dixon out-of-phase images using India ink artifact as a landmark for the subchondral plate is repeatable and reproducible.

Meniscus position and size in knees with versus without structural knee osteoarthritis progression: data from the osteoarthritis initiative

ObjectiveTo explore whether and which quantitative 3D measures of medial and/or lateral meniscus position and size are associated with subsequent medial femorotibial structural progression of knee osteoarthritis and to determine the correlation between central slice and total meniscus measures.Materials and MethodsKnees with radiographic osteoarthritis from Osteoarthritis Initiative participants with longitudinal medial MRI-based cartilage thickness and radiographic joint space width (JSW) loss over 12 months were selected. These 37 structural progressor knees (64.7 ± 8.0y, 30.2 ± 4.6 kg/m2, 35% men) were matched 1:1 to 37 non-progressor knees (64.6 ± 9.8y, 30.2 ± 4.4 kg/m2, 35% men) without cartilage thickness or JSW loss. Quantitative measures of meniscus position and size were computed from manual segmentations of coronal baseline MRIs. Cohen’s D was used as measure of effect size.ResultsMaximum extrusion distance of the total medial meniscus and mean extrusion in the central 5 and in the central slice were greater for progressor than non-progressor knees (Cohen’s D 0.58–0.66). No significant differences were observed for medial tibial coverage or mean extrusion (entire meniscus). Among medial meniscus morphology measures, only mean height differed between progressor vs non-progressor knees (Cohen’s D 0.40). Among lateral meniscus measures, height and volume were greater in progressor vs. non-progressor knees (Cohen’s D 0.46–0.83). Mean extrusion measures were highly correlated between the entire meniscus and the central (r = 0.88) or the central 5 (r = 0.93) slices.Conclusions3D maximum and central medial meniscus extrusion may serve as predictors for subsequent structural progression. Central meniscus extrusion measures could substitute 3D extrusion measurement across the entire meniscus.

Short-term changes in radiographic joint space width after jiggling exercise as conservative treatment for hip osteoarthritis: A retrospective case series of nine patients.

Jiggling exercise is a conservative treatment for hip osteoarthritis, which involves continuous shaking of the foot and leg in small oscillations while seated. Previous studies have shown beneficial effects of jiggling exercises for outpatients with advanced- and terminal-stage hip osteoarthritis when performed for longer than 1 year, including increases in joint space width and remission of symptoms. We aimed to use the data from our own treatment to evaluate the short-term impact of intensive jiggling exercises on inpatients with hip osteoarthritis to further examine the clinical utility of this exercise. This retrospective case series study included nine patients (57 ± 12 years) with nine hip joints with advanced- or terminal-stage hip osteoarthritis who performed continuous daily jiggling exercises, beginning from day of hospitalization to 6 months post-discharge. Jiggling exercise was performed seated, using the KENKO YUSURI® automated heel vibrating machine at 3.3–5.0 Hz. The patients were also instructed against weight-bearing during hospitalization. The values of radiographic joint space width and Japanese Orthopaedic Association hip score for pain at hospital admission, discharge, and at the 6-month post-discharge checkup were evaluated. Although the hospitalization period and daily time spent performing the jiggling exercise varied in each case (27–98 days and 2–6 hours, respectively), the joint space width increased in all patients and there was an improvement in the hip pain scores in eight patients. The mean values of the minimum joint space width and hip pain scores at discharge were the highest compared to those at hospital admission and 6 months post-discharge. Our results suggest that intensive jiggling exercise for inpatients with advanced- and terminal-stage hip osteoarthritis leads to earlier improvement in joint space width and pain. Daily jiggling exercise for an adequate duration or in combination with non-weight-bearing practices may be a feasible conservative treatment for hip osteoarthritis.

Long-term structural and symptomatic effects of intra-articular sprifermin in patients with knee osteoarthritis: 5-year results from the FORWARD study

ObjectiveThe FORWARD (FGF-18 Osteoarthritis Randomized Trial with Administration of Repeated Doses) trial assessed efficacy and safety of the potential disease-modifying osteoarthritis drug (DMOAD) sprifermin in patients with knee osteoarthritis. Here,...

Weight-bearing CT for Knee Osteoarthritis Assessment: A Story Unfolds

Weight-bearing CT for Knee Osteoarthritis Assessment: A Story Unfolds

Heterogeneity and natural history of medial fixed joint space width in healthy knees and knees with symptomatic osteoarthritis

Purpose: Radiographic joint space width (JSW) is an FDA-accepted measure of structure in randomized controlled trials. The distribution and natural history of JSW among healthy knees as compared to diseased knees has not been established. Our objective is to compare sex-specific distributions of medial and lateral fixed JSW (fJSW) among healthy knees, as compared to JSW among knees with symptomatic radiographic knee OA (SxROA). Methods: We identified healthy knees from the OAI, defined as knees with no evidence of OA (i.e., Kellgren-Lawrence grade [KLG] grade 0) and without reported frequent knee pain (i.e., pain on more than half the days of the past 30 days). SxROA knees were defined as KLG 2 or 3 with frequent knee pain. We estimated the distribution of medial fJSW(x=0.250) from fixed flexion PA radiographs for healthy knees and knees with SxROA during OAI follow-up, using age as the metameter of time. We fitted a mixed model with random intercepts and slopes to account for repeated measures within knees and knees within participants, and estimated the difference in mean medial fJSW for men and women, as well as sex-specific rates of JSW loss. Results: The sample consisted of 993 participants who contributed 1,294 knees with at least one healthy timepoint, for a total of 4,705 healthy timepoint observations; 1,159 participants who contributed 1,502 knees with at least one SxKL2 timepoint for a total of 3,130 SxKL2 timepoint observations; and 909 participants who contributed 1,133 knees with at least one SxKL3 timepoint for a total of 2,345 SxKL3 timepoint observations. Figure 1 shows the distribution of medial fJSW in healthy knees from age 45 to 85 for men and women. Among healthy knees, the estimated mean medial fJSW was greater in men compared to women (difference of 0.94 mm; [95%CI: 0.82, 1.07]. The mean rate of medial fJSW loss was -0.45 mm (95%CI: -0.54, -0.38) over 10 years for men, and -0.31 (95%CI: -0.39, -0.24) over 10 years for women, a difference of 0.14 (95%CI: 0.04, 0.25). As shown in Figure 2, compared to healthy knees (2a), there is greater heterogeneity in the distribution of medial fJSW in KL2 and KLG 3 knees with SxROA (Figures 2b and 2c, respectively). Conclusions: The natural history of medial fJSW among healthy knees is gradual loss with age. Heterogeneity of medial fJSW in healthy knees was observed at all ages between 45 and 85 years. Among healthy knees, women had less fJSW than men across the spectrum of age, though women lost medial fJSW at a lower rate with age compared to men. While the distributions of medial fJSW in healthy knees and those with SxROA overlapped considerably, the distribution of medial fJSW in knees with SxROA exhibited greater heterogeneity compared to healthy knees. These findings aid our understanding of the natural history of fJSW among healthy knees and knees with SxROA and provides information for the planning and interpretation of OA clinical trials.Figure2Medial Fixed Joint Space Width in Healthy Knees and Knees with SymptomaticRadiographic Osteoarthritis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)