Relevant change in radiological progression in patients with hip osteoarthritis. I. Determination using predictive validity for total hip arthroplasty (original) (raw)
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Arthritis Res …, 2005
Joint space width (JSW) and narrowing (JSN) measurements on radiographs are currently the best way to assess disease severity or progression in hip osteoarthritis, yet we lack data regarding the most accurate and sensitive measurement technique. This study was conducted to determine the optimal radiograph and number of readers for measuring JSW and JSN. Fifty pairs of radiographs taken three years apart were obtained from patients included in a structure modification trial in hip osteoarthritis. Three radiographs were taken with the patient standing: pelvis, target hip anteroposterior (AP) and oblique views. Two trained readers, blinded to each other's findings, time sequence and treatment, each read the six radiographs gathered for each patient twice (time interval ≥15 days), using a 0.1 mm graduated magnifying glass. Radiographs were randomly coded for each reading. The interobserver and intraobserver cross-sectional (M0 and M36) and longitudinal (M0-M36) reproducibilities were assessed using the intraclass coefficient (ICC) and Bland-Altman method for readers 1 and 2 and their mean. Sensitivity to change was estimated using the standardized response mean (SRM = change/standard deviation of change) for M0-M36 changes. For interobserver reliability on M0-M36 changes, the ICCs (95% confidence interval [CI]) were 0.79 (0.65-0.88) for pelvic view, 0.87 (0.78-0.93) for hip AP view and 0.86 (0.76-0.92) for oblique view. Intraobserver reliability ICCs were 0.81 (0.69-0.89) for observer 1 and 0.97 (0.95-0.98) for observer 2 for the pelvic view; 0.87 (0.78-0.92) and 0.97 (0.96-0.99) for the hip AP view; and 0.73 (0.57-0.84) and 0.93 (0.88-0.96) for the oblique view. SRMs were 0.61 (observer 1) and 0.82 (observer 2) for pelvic view; 0.64 and 0.75 for hip AP view; and 0.77 and 0.70 for oblique view. All three views yielded accurate JSW and JSN. According to the best reader, the pelvic view performed slightly better. Both readers exhibited high precision, with SRMs of 0.6 or greater for assessing JSN over three years. Selecting a single reader was the most accurate method, with 0.3 mm precision. Using this cutoff, 50% of patients were classified as 'progressors'. AP = anteroposterior; CI = confidence interval; ICC = intraclass coefficient of correlation; JSN = joint space narrowing; JSW = joint space width; OA = osteoarthritis; SD = standard deviation; SDD = smallest detectable difference; SRM = standardized response mean; WOMAC = Western and Ontario MacMaster University.
Arthritis Care & Research, 2010
To investigate whether knowledge of the sequence of radiographs impacts inter-and intraobserver reproducibility and sensitivity to change for measuring joint space width (JSW) in patients with knee osteoarthritis (OA). Methods. A cohort of 70 postmenopausal women with radiologic knee OA was assessed through the measurement of knee radiographs acquired in the semiflexed posteroanterior view, using a positioning frame and fluoroscopy, at baseline and 48 months later. Paired readings of radiographs were made using landmarks at baseline by 2 independent observers unblinded to sequence and blinded to sequence. . For the Bland-Altman method, the mean difference was close to 0, with no bias for both observers and methods. The SRMs ranged from 0.38 to 0.48. All of the results were numerically in favor of measuring with knowledge of time sequence, but without a statistically significant difference between the methods. Conclusion. Intra-and interobserver reproducibility was high with or without blinding of the radiograph sequence. Reading with knowledge of time sequence using baseline landmarks tended to improve sensitivity. Therefore, in longitudinal studies of OA radiographs can be read unblinded to sequence.
Osteoarthritis and Cartilage, 2009
Background: Measurement of radiographic joint space width (JSW) and of joint space narrowing (JSN) is the currently recommended method for assessment of anatomical severity and structural progression of osteoarthritis (OA), respectively. A standard radiographic view of the pelvis is commonly used for measurement of hip OA but other views are available. Objectives: To evaluate the intereintra reader reproducibility and the sensitivity to change of a new automated method of measurement of the hip JSW and to assess which radiographic view [pelvis anteroposterior (AP) view, hip AP view, hip oblique view] provides the greatest accuracy for JSW and JSN measurements. Material and methods: An AP pelvis radiograph, an AP radiograph centered on the target hip (AP hip) and an oblique view were performed at baseline (M0) and 3 years later (M36) in 50 hip OA patients. Two readers, blinded to each other's results and time sequence, measured twice, at a minimum 15 day interval, the six radiographs of each patient, using a novel version of a previously validated software program whose edge-based algorithm automatically detects the joint space contours. Inter-observer cross-sectional (M0 þ M36) and longitudinal (M0 À M36) reproducibility of JSW measurement was assessed by the intra-class correlation coefficient (ICC) and the BlandeAltman method. Sensitivity to change was estimated by the standardized response mean (SRM). An ANOVA was used to analyze differences related to the observer and the view. Results: Intra-observer reproducibility: For JSW measurement, the ICC value, for observers 1 and 2 respectively, were 0.92 and 0.83 for the pelvic view, 0.96 and 0.88 for the hip AP view, and 0.90 and 0.86 for the oblique view. For JSN, ICC was 0.94 and 0.82 for the pelvic view, 0.97 and 0.78 for the hip AP view, and 0.95 and 0.86 for the oblique view. Inter-observer reproducibility: For JSW measurement, ICC was 0.87 for the pelvic view, 0.98 for the hip AP view, and 0.87 for the oblique view. The mean inter-observer difference (SD) was 0.0 (0.31), À0.01 (0.15) and À0.04 (0.4) mm for pelvic, AP and oblique views respectively. For JSN, ICC was 0.91 for the pelvic view, 0.93 for the hip AP view, and 0.90 for the oblique view. Sensitivity to change: SRM values were 0.61 (observer 1) and 0.65 (observer 2) for the pelvic view, 0.68 and 0.75, respectively, for the hip AP view, 0.64 and 0.66, respectively, for the oblique view. JSN did not vary significantly with the observer and the view. In 27% of cases intervention by the observer was necessary to correct the computer's identification of the acetabular edge in the area of interest. Conclusion: Computer measurement of the radiographic hip joint space provided good intra-and inter-observer reproducibility and good sensitivity to change. However, it was necessary for the observer to intervene frequently to select the area of interest and adjust detection of the bone edge. The hip AP view performed better than the pelvis and oblique views, but not significantly so.
Arthritis research & therapy, 2005
Joint space width (JSW) and narrowing (JSN) measurements on radiographs are currently the best way to assess disease severity or progression in hip osteoarthritis, yet we lack data regarding the most accurate and sensitive measurement technique. This study was conducted to determine the optimal radiograph and number of readers for measuring JSW and JSN. Fifty pairs of radiographs taken three years apart were obtained from patients included in a structure modification trial in hip osteoarthritis. Three radiographs were taken with the patient standing: pelvis, target hip anteroposterior (AP) and oblique views. Two trained readers, blinded to each other's findings, time sequence and treatment, each read the six radiographs gathered for each patient twice (time interval > or = 15 days), using a 0.1 mm graduated magnifying glass. Radiographs were randomly coded for each reading. The interobserver and intraobserver cross-sectional (M0 and M36) and longitudinal (M0-M36) reproducibil...
The Journal of rheumatology, 2002
To compare the intraobserver reliability and the sensitivity to change of 2 techniques evaluating the cartilage breakdown in hip osteoarthritis (OA). 3 year longitudinal study. patients with painful hip OA. coxofemoral joint space width (JSW) at baseline and at 3 year followup was measured on anteroposterior weight-bearing radiographs by 2 methods: a manual method to obtain JSW at the narrowest point (minimal JSW) using a 0.1 mm graduated magnifying glass and a computer based method to obtain minimal and average JSW. Two assessments, at one month interval, of each pair of films; evaluation of the intraobserver reliability using the intraclass coefficient of correlation, and the Bland and Altman approach, obtaining the smallest detectable difference (SDD). For each technique, percentage of progressors was evaluated, i.e., the percentage of patients with change greater than the SDD. Evaluation of sensitivity to change was performed using the standardized response mean (SRM), with 95% ...
A novel quantitative metric for joint space width: data from the Osteoarthritis Initiative (OAI)
Osteoarthritis and Cartilage
Objective: Joint space width (JSW) has been the gold standard to assess loss of cartilage in knee osteoarthritis (OA). Here we describe a novel quantitative measure of joint space width: standardized JSW (stdJSW). We assess the performance of this quantitative metric for JSW at tracking Osteoarthritis Research Society International (OARSI) joint space narrowing grade (JSN) changes and provide reference values for different JSN grades and their annual change. Methods: We collected 18,934 individual knee images along with JSW and JSN readings from baseline up to month 48 (4 follow-ups) from the OAI study. Standardized JSW and 12-month JSN grade changes were calculated for each knee. For each JSN grade and 12-month grade change, the distribution of JSW loss was calculated for JSW and stdJSW. Area under the ROC curves was calculated on discrimination between different JSN grades for JSW and stdJSW. Standardized response mean (SRM) was used to compare the responsiveness of the two measures to changes in JSN grade. Results: The areas under the receiver operating characteristic (ROC) curve (AUC) for stdJSW at discriminating between successive JSN grades were AUC stdJSW ¼ 0.87, 0.95, and 0.96, for JSN>0, JSN>1 and JSN>2, respectively, whereas these were AUC fJSW ¼ 0.79, 0.90, 0.98 for absolute JSW. We find that standardized JSW is significantly more responsive than absolute JSW, as measured by the SRM. Conclusions: Our results show that stdJSW outperforms absolute JSW at discriminating and tracking changes in JSN and further that this effect is in part because stdJSW cancels JSW variations attributed to patient height variations.
Annals of The Rheumatic Diseases, 1998
Objectives-(1) To assess reproducibility of medial knee joint space width (JSW) measurement in healthy subjects and osteoarthritic (OA) patients. (2) To define minimal relevant radiological change in knee JSW based on the reproducibility of its measurement. Patients and methods-(1) Healthy volunteers: in the first part of the study, 20 knees of healthy adult volunteers were radiographed in the weightbearing, anteroposterior extended view, twice, two weeks apart, using three diVerent radiographic procedures: (a) without guidelines, (b) with guidelines and without fluoroscopy, (c) with guidelines and fluroroscopy. (2) Knee OA patients: in the second part of the study, 36 knees of OA patients were radiographed twice with guidelines and without fluoroscopy. JSW was measured blindly using a graduated magnifying glass. Based on the Bland and Altman graphic approach, cut oV points defining minimal relevant radiological change are proposed. Results-Standard deviation (SD) of differences in JSW measurement between two sets of knee radiographs in healthy subjects were 0.66 mm for radiography performed without guidelines, 0.37 mm for radiography performed with guidelines and without fluoroscopy, and 0.31 mm for radiography with guidelines and fluoroscopy. SD of diVerences in JSW measurement in OA patients were 0.32 mm for radiography performed with guidelines and without fluoroscopy. A minimal relevant change in JSW between two radiographs performed in healthy subjects can be defined by a change of at least 1.29 or 0.59 mm when radiographs are taken without guidelines, and with guidelines and fluoroscopy, respectively. When radiographs are taken with guidelines and without fluoroscopy, the change must be at least 0.73 mm. A similar figure, 0.64 mm was observed in knee OA patients. Conclusion-Definition of radiological progression varies greatly according to the radiographic procedure chosen. Use of guidelines reduces the threshold of progression required to consider that change between two measures is relevant.