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Ultrasonography superior to radiography in osteoarthritis prediction, study finds
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Ultrasonography is superior to conventional radiography in predicting the outcome of diagnostic arthroscopy for osteoarthritis, according to Finnish researchers.
The study was presented at the 2011 Orthopaedic Research Society Annual Meeting. Lead researcher Simo Saarakkala, PhD, discussed his group’s findings with Orthopaedics Today Europe.
Though both methods are patient-friendly and noninvasive ways to assess knee osteoarthritis (OA), the researchers wanted to determine how ultrasonography’s performance compared to conventional radiography.
“Our results suggest that noninvasive ultrasonography of the knee joint predicts the OA findings from arthroscopy significantly better than conventional radiography with Kellgren-Lawrence grading,” he told Orthopaedics Today Europe. “Therefore, we believe that early OA can be better diagnosed with noninvasive ultrasonography than with knee radiography. As such, we recommend that when early OA is suspected, knee radiography should be complemented with noninvasive ultrasonography when possible.”
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Images: Saarakkala S. |
Study methods
The group looked at 40 non-rheumatoid patients undergoing a diagnostic arthroscopy for knee pain. Among the patients were 15 women and 25 men, with a mean age of 52 years. Ultrasonographic examination of the affected knee was conducted for each patient prior to the arthroscopic procedure which assessed the femoral and tibial cartilage surfaces.
The investigators used a grading system that included evaluation of joint effusion, synovitis, presence of femoral and tibial osteophytes, and degeneration of femoral condylar cartilage.
These findings were all compared with conventional knee radiographs taken in the standing position, which were available for 32 of the patients and evaluated using the Kellgren-Lawrence (K-L) grading system. These comparisons were made using statistical evaluation through Spearman’s correlation analysis and multiple linear regression analysis of K-L grading and ultrasonography scores.
Saarakkala reported that the group observed the ultrasonography score to be “a significant predictor” for arthroscopic score, noting its performance in the multiple linear regression model was superior to K-L grade. These findings were attributed to the better sensitivity of ultrasonography scoring, since other aspects of OA — joint effusion, synovitis and osteophytes — can be evaluated together with cartilage status.
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Significance of finding
The authors noted the significance of this finding is due to the widespread use of conventional radiography and clinical evaluation in estimating the OA status of a patient’s knee.
“In the Mikkeli Central Hospital, Finland, ultrasonography scanning has replaced plain radiographs in the evaluation of OA of the knee joint in the clinical practice of rheumatology,” Saarakkala said. “Ultrasonography not only shows the cartilage changes reliably enough, but also the existence of osteophytes and signs of inflammation — effusion and synovial hyperplasia.”
“Other soft tissue changes around the knee joint, such as bursitis, tendinitis, protrusion and cysts of the menisci, can also be evaluated at the same time,” he added. “Thus, ultrasonography gives more information of the knee for the clinician without radiation than plain radiographs.” – by Robert Press
Reference:
- Saarakkala S, et al. Statistical comparison of noninvasive ultrasonography and radiography of knee joint to predict arthroscopic findings for osteoarthritis. Paper #211. Presented at the 2011 Orthopaedic Research Society Annual Meeting. Jan. 13-16. Long Beach, Calif., USA.
- Simo Saarakkala, PhD, can be reached at simo.saarakkala@oulu.fi.
- Disclosure: Saarakkala and co-authors have no relevant financial disclosures.
