Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2000 Jun;59(6):422–427. doi: 10.1136/ard.59.6.422

Radiographic assessment of hip osteoarthritis progression: impact of reading procedures for longitudinal studies

G Auleley 1, B Giraudeau 1, M Dougados 1, P Ravaud 1
PMCID: PMC1753172  PMID: 10834858

Abstract

OBJECTIVE—To compare radiographic reading procedures and evaluate their impact on sample size in hip osteoarthritis (OA) longitudinal studies.
METHODS—Pelvic radiographs performed twice, three years apart, in 104 patients with hip OA were read by a single reader using the Kellgren and Lawrence system, joint space narrowing scale, and joint space width (JSW). Reading procedures were (a) films read as single radiographs, (b) films grouped by patient but read in random order, (c) films grouped by patient and chronologically ordered, all with landmarks for JSW measurements, (d) films read as single radiographs, without landmarks for JSW measurements. JSW was measured at the narrowest point with a 0.1 mm graduated magnifying glass.
RESULTS— More Kellgren and Lawrence or joint space narrowing grades were modified respectively with the single (42% and 37%) than with the paired (32% and 23%) or chronologically ordered (34% and 29%) reading procedures. Variability of JSW progression was principally related to mean progression (88.3%) and landmarks (almost 10%). Standardised response means were −0.71 with the paired reading procedure with landmarks, −0.68 with the single reading procedure with landmarks, −0.65 with the single reading procedure without landmarks. With landmarks, 10% more patients would be needed using single than paired reading. Using single reading, 10% more patients would be needed without landmarks than with landmarks.
CONCLUSION—Kellgren and Lawrence grading seems to be influenced by the reading procedure, as is joint space narrowing grading, for assessing hip OA. Paired reading procedure with landmarks for JSW should be recommended in longitudinal studies.



Full Text

The Full Text of this article is available as a PDF (121.8 KB).

Figure 1  .

Figure 1  

Open in a new tab

Distribution of changes in Kellgren and Lawrence score and joint space narrowing score using three reading procedures in 104 patients with hip osteoarthritis.

Figure 2  .

Figure 2  

Open in a new tab

Distribution of the progression in joint space width (JSW) using four reading procedures in 104 patients with hip osteoarthritis.

Figure 3  .

Figure 3  

Open in a new tab

Principal component analysis on change in joint space width measurements using four reading procedures in 104 patients with hip osteoarthritis. The first principal component accounts for 88.3% of the total variability. All the four coefficients are positive and nearly equal, thus allowing the assertion that this component is a measure of global time variation value. The second principal component opposes the single reading procedure without landmarks to the three other reading procedures. This component, which accounts for 9.8% of total variability, then reflects the advantage of using landmarks.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altman R. D., Fries J. F., Bloch D. A., Carstens J., Cooke T. D., Genant H., Gofton P., Groth H., McShane D. J., Murphy W. A. Radiographic assessment of progression in osteoarthritis. Arthritis Rheum. 1987 Nov;30(11):1214–1225. doi: 10.1002/art.1780301103. [DOI] [PubMed] [Google Scholar]
  2. Altman R. D., Hochberg M., Murphy W. A., Jr, Wolfe F., Lequesne M. Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage. 1995 Sep;3 (Suppl A):3–70. [PubMed] [Google Scholar]
  3. Altman R. D. The classification of osteoarthritis. J Rheumatol Suppl. 1995 Feb;43:42–43. [PubMed] [Google Scholar]
  4. Altman R., Alarcón G., Appelrouth D., Bloch D., Borenstein D., Brandt K., Brown C., Cooke T. D., Daniel W., Feldman D. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991 May;34(5):505–514. doi: 10.1002/art.1780340502. [DOI] [PubMed] [Google Scholar]
  5. Dieppe P. A., Cushnaghan J., Shepstone L. The Bristol 'OA500' study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint. Osteoarthritis Cartilage. 1997 Mar;5(2):87–97. doi: 10.1016/s1063-4584(97)80002-7. [DOI] [PubMed] [Google Scholar]
  6. Dieppe P. A. Recommended methodology for assessing the progression of osteoarthritis of the hip and knee joints. Osteoarthritis Cartilage. 1995 Jun;3(2):73–77. doi: 10.1016/s1063-4584(05)80040-8. [DOI] [PubMed] [Google Scholar]
  7. Dieppe P., Brandt K. D., Lohmander S., Felson D. T. Detecting and measuring disease modification in osteoarthritis. The need for standardized methodology. J Rheumatol. 1995 Feb;22(2):201–203. [PubMed] [Google Scholar]
  8. Dougados M., Gueguen A., Nguyen M., Berdah L., Lequesne M., Mazieres B., Vignon E. Radiological progression of hip osteoarthritis: definition, risk factors and correlations with clinical status. Ann Rheum Dis. 1996 Jun;55(6):356–362. doi: 10.1136/ard.55.6.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Ferrara R., Priolo F., Cammisa M., Bacarini L., Cerase A., Pasero G., Ferraccioli G. F., Alberighi O. D., Antonellini A., Marubini E. Clinical trials in rheumatoid arthritis: methodological suggestions for assessing radiographs arising from the GRISAR Study. Gruppo Reumatologi Italiani Studio Artrite Reumatoide. Ann Rheum Dis. 1997 Oct;56(10):608–612. doi: 10.1136/ard.56.10.608. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fortin P. R., Stucki G., Katz J. N. Measuring relevant change: an emerging challenge in rheumatologic clinical trials. Arthritis Rheum. 1995 Aug;38(8):1027–1030. doi: 10.1002/art.1780380802. [DOI] [PubMed] [Google Scholar]
  11. Fries J. F., Bloch D. A., Sharp J. T., McShane D. J., Spitz P., Bluhm G. B., Forrester D., Genant H., Gofton P., Richman S. Assessment of radiologic progression in rheumatoid arthritis. A randomized, controlled trial. Arthritis Rheum. 1986 Jan;29(1):1–9. doi: 10.1002/art.1780290101. [DOI] [PubMed] [Google Scholar]
  12. Hart D. J., Spector T. D. Radiographic criteria for epidemiologic studies of osteoarthritis. J Rheumatol Suppl. 1995 Feb;43:46–48. [PubMed] [Google Scholar]
  13. KELLGREN J. H., LAWRENCE J. S. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494–502. doi: 10.1136/ard.16.4.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ledingham J., Dawson S., Preston B., Milligan G., Doherty M. Radiographic progression of hospital referred osteoarthritis of the hip. Ann Rheum Dis. 1993 Apr;52(4):263–267. doi: 10.1136/ard.52.4.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Murphy W. A., Jr, Altman R. D. Updated osteoarthritis reference standard. J Rheumatol Suppl. 1995 Feb;43:56–59. [PubMed] [Google Scholar]
  16. Ravaud P., Dougados M. Radiographic assessment in osteoarthritis. J Rheumatol. 1997 Apr;24(4):786–791. [PubMed] [Google Scholar]
  17. Ravaud P., Giraudeau B., Auleley G. R., Chastang C., Poiraudeau S., Ayral X., Dougados M. Radiographic assessment of knee osteoarthritis: reproducibility and sensitivity to change. J Rheumatol. 1996 Oct;23(10):1756–1764. [PubMed] [Google Scholar]
  18. Ravaud P., Giraudeau B., Auleley G. R., Drape J. L., Rousselin B., Paolozzi L., Chastang C., Dougados M. Variability in knee radiographing: implication for definition of radiological progression in medial knee osteoarthritis. Ann Rheum Dis. 1998 Oct;57(10):624–629. doi: 10.1136/ard.57.10.624. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Speake S. C., Szebenyi B., Dieppe P. A. Quantitative serial assessment of patellofemoral joint osteoarthritis from lateral knee radiographs. Osteoarthritis Cartilage. 1995 Sep;3 (Suppl A):89–96. [PubMed] [Google Scholar]
  20. Spector T. D., Hochberg M. C. Methodological problems in the epidemiological study of osteoarthritis. Ann Rheum Dis. 1994 Feb;53(2):143–146. doi: 10.1136/ard.53.2.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Tuley M. R., Mulrow C. D., McMahan C. A. Estimating and testing an index of responsiveness and the relationship of the index to power. J Clin Epidemiol. 1991;44(4-5):417–421. doi: 10.1016/0895-4356(91)90080-s. [DOI] [PubMed] [Google Scholar]
  22. van Der Heijde D., Boonen A., Boers M., Kostense P., van Der Linden S. Reading radiographs in chronological order, in pairs or as single films has important implications for the discriminative power of rheumatoid arthritis clinical trials. Rheumatology (Oxford) 1999 Dec;38(12):1213–1220. doi: 10.1093/rheumatology/38.12.1213. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES