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Can anatomic alignment measured from a knee radiograph substitute for mechanical alignment from full limb films?

Abstract：

OBJECTIVES:To examine whether categories of anatomic alignment (varus, neutral, valgus) measured from knee X-rays agree with similar categories of mechanical alignment from the full limb film and whether varus anatomic malalignment predicts medial joint space loss on knee X-rays as well as varus mechanical alignment. METHODS:We used data from the Osteoarthritis Initiative (OAI) (full limb and flexed knee X-rays) to examine agreement of anatomic and mechanical alignment and data from Boston Osteoarthritis of the Knee Study (BOKS) to evaluate the association of full limb mechanical alignment vs knee X-ray anatomic alignment with joint space loss. A 4 degree offset was used to correct for the more valgus angulation of the anatomic alignment. RESULTS:Of 143 subjects whose knee X-rays and full limb films were publicly released from the OAI, the agreement of varus, neutral and valgus alignment was only moderate (kappa=0.43, P<0.001). In BOKS, varus mechanical and anatomic alignments measured from full limb and knee X-rays respectively both predicted a high risk of medial joint space loss vs neutral alignment--for mechanical alignment, odds ratio (OR)=4.82 [95% confidence interval (CI) 1.93, 12.00] and for anatomic alignment OR=4.25 (95% CI 2.08, 8.72). CONCLUSIONS:While agreement of alignment from knee X-ray to full limb film was only moderate, varus malalignment measured from a flexed knee predicted the likelihood of progression well. Flexed knee alignment may be more relevant to knee osteoarthritis (OA) risk than that of a fully extended knee, but a measurement of alignment from a short limb is an imperfect surrogate for full limb alignment.

journal_name

Osteoarthritis Cartilage

journal_title

Osteoarthritis and cartilage

authors

Felson DT,Cooke TD,Niu J,Goggins J,Choi J,Yu J,Nevitt MC,OAI Investigators Group.

doi

10.1016/j.joca.2009.05.012

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

1448-52

issue

11

eissn

1063-4584

issn

1522-9653

pii

S1063-4584(09)00149-6

journal_volume

17

pub_type

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