A Comparative Analysis of the Standing Weight-Bearing Anteroposterior View Versus the Rosenberg View Radiographs and Their Correlation With Oxford Knee Scores in Grading Osteoarthritis of the Knee Joint

TL;DR

This study compares two X-ray views for diagnosing knee osteoarthritis and finds that the Rosenberg view is better at detecting early and severe cases.

Contribution

The study introduces the Rosenberg view as a more sensitive radiographic method for grading knee osteoarthritis compared to the standard AP view.

Findings

The Rosenberg view identified more severe knee osteoarthritis cases than the standard AP view.

There was a strong correlation between joint space width measurements in both radiographic views.

The Rosenberg view showed superior sensitivity in detecting early disease progression.

Abstract

Introduction: Knee osteoarthritis (KOA) is a chronic degenerative condition characterized by joint space narrowing (JSN), pain, and functional limitations, affecting a significant portion of the population in India. Radiographic evaluation (standing anteroposterior (AP) view - standard technique) is crucial for diagnosing and grading KOA. The aim of this study was to evaluate the efficacy of the Rosenberg posteroanterior (PA) view compared to the standard anteroposterior (AP) view in grading KOA and to estimate the correlation between joint space width (JSW), radiographic grading, and the Oxford knee score (OKS).

Materials and methods: A total of 384 knees (192 patients) aged 40 years and above, presenting with knee pain, were included in this cross-sectional study. Radiographs of the standing AP and Rosenberg views were taken, and the medial and lateral tibiofemoral JSW were measured digitally on calibrated images. KOA was graded using the International Knee Documentation Committee (IKDC) classification. Statistical analysis included Spearman’s rho correlation coefficient, with significance set at p<0.05.

Results: The mean medial JSW was 3.91±0.89 mm in the AP view and 3.52±1.02 mm in the Rosenberg view, with a strong correlation (p<0.0001). The mean lateral JSW was similar between views (5.88±0.47 mm in AP and 5.89±0.43 mm in Rosenberg), showing moderate correlation (p<0.0001). The Rosenberg view identified more severe KOA grades, with 41.9% of patients classified as IKDC Grade 3 or higher, compared to 27.6% in the AP view. Additionally, 18.2% of patients were reclassified to a more severe grade in the Rosenberg view, indicating its superior sensitivity in detecting early disease progression.

Conclusion: The Rosenberg view is more effective in detecting early and severe KOA, providing a more accurate assessment of disease severity for improved management.

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