Optimum radiographic assessment of the knee
Research type
Research Study
Full title
Optimum radiographic assessment of the medial and lateral tibiofemoral compartments within the arthritic knee
IRAS ID
147869
Contact name
Thomas Hamilton
Contact email
Sponsor organisation
Oxford University Hospitals NHS Trust
Duration of Study in the UK
1 years, 5 months, 31 days
Research summary
Xrays are the most frequently used imaging test when evaluating the knee for joint replacement. They are non-invasive, safe and cost effective. They allow assessment of: progression of disease, appropriateness for joint replacement (in particular unicompartmental (partial) replacement, where only the diseased portion of the joint is replaced) as well as likely prognosis following replacement. Despite a multitude of standardised views there is a lack of consensus regarding the optimum views to evaluate joint space narrowing within each compartment (lateral, medial and patellofemoral) that are both sensitive, specific at determining the pattern and severity of arthritis and use a technique that can be employed easily in clinical practice.
Currently standard assessment involves: standing anteroposterior, lateral and skyline views. In patients being considered for joint replacement valgus/varsus stress xrays evaluate the lateral and medial compartments respectively (as well as medial collateral ligament).
The use of stress views, whilst being the gold standard of assessment, can be uncomfortable for patients and they are resource intensive requiring an additional practitioner. It has been proposed that standing views with the knee in 15degrees then 45degrees flexion may load the medial and lateral compartments respectively as seen during walking and that these views may be an alternative to stress views without the requirement for an additional practitioner.
This study will evaluate the status of knee cartilage in 225 patients with varying degrees, and patterns, of knee OA using standing extension anteroposterior, 15 degrees flexion posteroanterior, 45 degrees flexion posteroanterior and valgus and varus stress views as well as MRI. These results will be compared to the gold standard imaging technique of stress views as well as to direct measurements of retrieved tissue in those patients who undergo knee replacement surgery. The sensitivity and specificity of each of the imaging techniques at predicting suitability for UKR will be calculated, the optimum imaging views proposed, and ultimately the results of this study will be used to develop a decision aid, based on optimum views, to help clinicians decide between likelihood of a patient being a candidate for UKR based on pre-operative xray and MRI findings.
REC name
South Central - Oxford B Research Ethics Committee
REC reference
15/SC/0476
Date of REC Opinion
5 Oct 2015
REC opinion
Further Information Favourable Opinion