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An accurate method for measuring knee joint space width despite variations in beam projection angles.

Sung Eun Kim1, Keehyun Kim1, Myung Chul Lee1

  • 1Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.

The Knee
|November 5, 2023
PubMed
Summary

Accurate knee osteoarthritis (OA) assessment using joint space width (JSW) is challenging. A new average distance (AVD) method using CT scans and X-rays shows reduced measurement errors from X-ray beam angle variations.

Keywords:
Beam projection angleJoint space widthKnee joint

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Area of Science:

  • Radiology
  • Orthopedics
  • Medical Imaging

Background:

  • Assessing knee osteoarthritis (OA) severity via joint space width (JSW) is hindered by anatomical variations, X-ray beam projection angle (BPA) errors, and patient posture.
  • Current methods lack a consensus reference point for precise JSW measurement, necessitating improved evaluation techniques.

Purpose of the Study:

  • To establish a precise and reliable method for measuring knee joint space width (JSW) that minimizes errors caused by variations in X-ray beam projection angles (BPAs).

Main Methods:

  • A simulation study using computed tomography (CT) derived digital radiographs of 30 knees with advanced OA was performed.
  • Joint space width (JSW) was measured using the distance between the medial femoral condyle and anterior/posterior borders of the medial tibial plateau (DAB, DPB) and their average (AVD).
  • The reliability of DAB, DPB, and AVD for JSW measurement was assessed in 100 knees using anteroposterior X-rays at neutral, 5° caudal, and 5° cephalic tilt BPAs.

Main Results:

  • The AVD method showed discrepancies below 1 mm from the 0° BPA for 5° and 10° caudal tilts and 5° cephalic tilt in simulations.
  • DAB and DPB measurements exhibited significant discrepancies (>1 mm) from the 0° BPA across various angles (all P < 0.001).
  • The AVD measurement demonstrated the least discrepancy in JSW measurements compared to DAB and DPB methods when accounting for BPA variations in the proof-of-concept study.

Conclusions:

  • The average distance (AVD) method provides a simple and accurate approach for measuring joint space width (JSW) in knee osteoarthritis (OA) assessment.
  • This method is effective even when X-rays are acquired at unintended angles, offering potential for improved clinical practice.