J Knee Surg 2018; 31(03): 247-253
DOI: 10.1055/s-0037-1602249
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Inter- and Intraobserver Reliabilities of Four Different Radiographic Grading Scales of Osteoarthritis of the Knee Joint

Özkan Köse
1   Department of Orthopaedics and Traumatology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
,
Baver Acar
1   Department of Orthopaedics and Traumatology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
,
Fatif Çay
2   Department of Physical Medicine and Rehabilitation, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
,
Baris Yilmaz
3   Department of Orthopaedics and Traumatology, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
,
Ferhat Güler
1   Department of Orthopaedics and Traumatology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
,
Halil Yalçın Yüksel
1   Department of Orthopaedics and Traumatology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
› Author Affiliations
Further Information

Publication History

27 June 2016

09 March 2017

Publication Date:
01 May 2017 (online)

Abstract

The purpose of this study was to investigate the interobserver and intraobserver reliabilities of four different radiographic grading scale of osteoarthritis (OA) of the knee joint, namely, Kellgren–Lawrence (KL), Ahlback, Brandt, and OA Research Society International (OARSI). One consultant orthopaedic surgeon and one rheumatologist who were familiar with these OA grading scales participated in the study. Radiological assessments were performed in random order by each observer on two separate occasions, at least 2 weeks apart. K-statistics were used to establish a relative level of agreement between the observers for the two readings and between separate readings by the same observer. A total of 140 patients (53 males and 87 females) with a mean age of 61.2 years (range, 50–72 years) were included in the study. Intraobserver reliability for KL was substantial for observer A (κ: 0.753) and moderate for observer B (κ: 0.573). Interobserver reliability for KL was moderate for both observers (κ: 0.499 and 0.458, respectively). Intraobserver reliability for Ahlback was substantial for observer A (κ: 0.768) and moderate for observer B (κ: 0.561). Interobserver reliability for Ahlback was fair for both observers (κ: 0.365 and 0.204, respectively). Intraobserver reliability for Brandt was substantial for observer A (κ: 0.741) and moderate (κ: 0.425) for observer B. Interobserver reliability for Brandt was fair for both observers (κ: 0.308 and κ: 0.246, respectively). Intraobserver reliability for OARSI was substantial for observer A (κ: 0.792) and moderate for observer B (κ: 0.508). Interobserver reliability for OARSI was moderate for observer A (κ: 0.425) and slight for observer B (κ: 0.175). None of the studied OA grading scales showed acceptable reliability (κ > 0.80). The evaluation of patients with OA should not be dependent on radiographic findings alone; clinical findings should also guide the treatment and follow-up.

 
  • References

  • 1 Grainger R, Cicuttini FM. Medical management of osteoarthritis of the knee and hip joints. Med J Aust 2004; 180 (05) 232-236
  • 2 Buckland-Wright JC, Macfarlane DG, Lynch JA, Jasani MK, Bradshaw CR. Joint space width measures cartilage thickness in osteoarthritis of the knee: high resolution plain film and double contrast macroradiographic investigation. Ann Rheum Dis 1995; 54 (04) 263-268
  • 3 Hochberg MC, Weisman MH. OA and related disorders. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. , eds. Rheumatology, 4th ed. Spain: Mosby Elsevier; 2008: 1689-1802
  • 4 Hunter DJ, Lo GH. The management of osteoarthritis: an overview and call to appropriate conservative treatment. Rheum Dis Clin North Am 2008; 34 (03) 689-712
  • 5 Guermazi A, Eckstein F, Hellio Le Graverand-Gastineau MP. , et al. Osteoarthritis: current role of imaging. Med Clin North Am 2009; 93 (01) 101-126 , xi
  • 6 Ravaud P, Dougados M. Radiographic assessment in osteoarthritis. J Rheumatol 1997; 24 (Suppl. 04) 786-791
  • 7 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
  • 8 Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 1968; 277: 7-72
  • 9 Nagaosa Y, Mateus M, Hassan B, Lanyon P, Doherty M. Development of a logically devised line drawing atlas for grading of knee osteoarthritis. Ann Rheum Dis 2000; 59 (08) 587-595
  • 10 Wright RW. ; MARS Group. Osteoarthritis classification scales: interobserver reliability and arthroscopic correlation. J Bone Joint Surg Am 2014; 96 (14) 1145-1151
  • 11 Galli M, De Santis V, Tafuro L. Reliability of the Ahlbäck classification of knee osteoarthritis. Osteoarthritis Cartilage 2003; 11 (08) 580-584
  • 12 Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Washington: Biometrics; 1977
  • 13 Riddle DL, Jiranek WA, Hull JR. Validity and reliability of radiographic knee osteoarthritis measures by arthroplasty surgeons. Orthopedics 2013; 36 (01) e25-e32
  • 14 Agnesi F, Amrami KK, Frigo CA, Kaufman KR. Comparison of cartilage thickness with radiologic grade of knee osteoarthritis. Skeletal Radiol 2008; 37 (07) 639-643
  • 15 Park HJ, Kim SS, Lee SY. , et al. A practical MRI grading system for osteoarthritis of the knee: association with Kellgren-Lawrence radiographic scores. Eur J Radiol 2013; 82 (01) 112-117
  • 16 Laxafoss E, Jacobsen S, Gosvig KK, Sonne-Holm S. Case definitions of knee OA in 4,151 unselected subjects: relevance for epidemiological studies: the Copenhagen OA Study. Skeletal Radiol 2010; 39: 859-866
  • 17 Emrani PS, Katz JN, Kessler CL. , et al. Joint space narrowing and Kellgren-Lawrence progression in knee osteoarthritis: an analytic literature synthesis. Osteoarthritis Cartilage 2008; 16 (08) 873-882
  • 18 Felson DT, Nevitt MC, Yang M. , et al. A new approach yields high rates of radiographic progression in knee osteoarthritis. J Rheumatol 2008; 35 (10) 2047-2054
  • 19 Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Rheum Dis Clin North Am 2008; 34 (03) 515-529
  • 20 Sun Y, Günther KP, Brenner H. Reliability of radiographic grading of osteoarthritis of the hip and knee. Scand J Rheumatol 1997; 26 (03) 155-165
  • 21 Reichmann WM, Maillefert JF, Hunter DJ, Katz JN, Conaghan PG, Losina E. Responsiveness to change and reliability of measurement of radiographic joint space width in osteoarthritis of the knee: a systematic review. Osteoarthritis Cartilage 2011; 19 (05) 550-556
  • 22 Lequesne M, Brandt K, Bellamy N. , et al. Guidelines for testing slow acting drugs in osteoarthritis. J Rheumatol Suppl 1994; 41: 65-73
  • 23 Vignon E, Conrozier T, Piperno M, Richard S, Carrillon Y, Fantino O. Radiographic assessment of hip and knee osteoarthritis. Recommendations: recommended guidelines. Osteoarthritis Cartilage 1999; 7 (04) 434-436
  • 24 Ward RJ, Buckland-Wright JC. Rates of medial tibiofemoral joint space narrowing in osteoarthritis studies consistent despite methodological differences. Osteoarthritis Cartilage 2008; 16 (03) 330-336
  • 25 Weidow J, Cederlund CG, Ranstam J, Kärrholm J. Ahlbäck grading of osteoarthritis of the knee: poor reproducibility and validity based on visual inspection of the joint. Acta Orthop 2006; 77 (02) 262-266
  • 26 Gensburger D, Arlot M, Sornay-Rendu E, Roux JP, Delmas P. Radiologic assessment of age-related knee joint space changes in women: a 4-year longitudinal study. Arthritis Rheum 2009; 61 (03) 336-343
  • 27 Buckland-Wright C. Which radiographic techniques should we use for research and clinical practice?. Best Pract Res Clin Rheumatol 2006; 20 (01) 39-55
  • 28 Leach RE, Gregg T, Siber FJ. Weight-bearing radiography in osteoarthritis of the knee. Radiology 1970; 97 (02) 265-268
  • 29 Vignon E, Piperno M, Le Graverand MP. , et al. Measurement of radiographic joint space width in the tibiofemoral compartment of the osteoarthritic knee: comparison of standing anteroposterior and Lyon schuss views. Arthritis Rheum 2003; 48 (02) 378-384
  • 30 Duncan R, Peat G, Thomas E, Hay E, McCall I, Croft P. Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be?. Ann Rheum Dis 2007; 66 (Suppl. 01) 86-91
  • 31 Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord 2008; 9: 116
  • 32 Hayashi D, Guermazi A, Crema MD, Roemer FW. Imaging in osteoarthritis: what have we learned and where are we going?. Minerva Med 2011; 102 (01) 15-32
  • 33 Kijowski R, Blankenbaker D, Stanton P, Fine J, De Smet A. Arthroscopic validation of radiographic grading scales of osteoarthritis of the tibiofemoral joint. Am J Roentgenol 2006; 187 (03) 794-799