Musa A A, Shamsuddin-Perisamy R, Low C L, Zulkifly A H, Kow R Y
Department of Orthopaedics, Traumatology and Rehabilitation, International Islamic University Malaysia, Kuantan, Malaysia.
Department of Radiology, International Islamic University Malaysia, Kuantan, Malaysia.
Malays Orthop J. 2025 Jul;19(2):50-56. doi: 10.5704/MOJ.2507.007.
Knee osteoarthritis is a degenerative joint disease attributed to failure in joint repair process. Key aspect of the diagnosis relies on thorough history, along with physical examination and radiology findings. The conventional weight-bearing plain radiograph remains the key modality to determine the severity of the condition and helps to plan the surgery. Nevertheless, not all patients can undergo weight-bearing plain radiographs, especially those who are wheelchair-bound or have severe deformities. The purpose of this study is to investigate whether a weight-bearing plain radiograph of the knee is essential in all patients with knee osteoarthritis.
A prospective cohort study on patients with knee osteoarthritis receiving treatment in a single tertiary hospital was conducted. All patients consented to participate in this study. Patients were assessed functionally with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and radiologically with plain radiographs. Patients were subjected to undergo both supine and standing plain radiographs of the knee in the same setting for comparison purposes where measurement is done following patient functional outcome and radiological measurement for the patient.
Our study shows that reduction in joint space is more obvious in weight-bearing radiographs, however in severe or higher-grade osteoarthritis, a supine radiograph is adequate to diagnose knee osteoarthritis.
Standing radiograph of the knee is preferred to a supine knee radiograph wherever possible due to the additional value it brings, however, in certain patient conditions, a supine radiograph is still acceptable.
膝关节骨关节炎是一种由于关节修复过程失败导致的退行性关节疾病。诊断的关键在于详细的病史、体格检查以及影像学检查结果。传统的负重位X线平片仍然是确定病情严重程度并有助于规划手术的关键检查方法。然而，并非所有患者都能进行负重位X线平片检查，尤其是那些需要轮椅辅助或有严重畸形的患者。本研究的目的是调查膝关节负重位X线平片对所有膝关节骨关节炎患者是否必不可少。
在一家三级医院对接受治疗的膝关节骨关节炎患者进行了一项前瞻性队列研究。所有患者均同意参与本研究。采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）对患者进行功能评估，并通过X线平片进行影像学评估。为了进行比较，患者在相同条件下接受仰卧位和站立位膝关节X线平片检查，测量在患者功能结局和影像学测量之后进行。
我们的研究表明，负重位X线平片中关节间隙的减小更为明显，然而在重度或高级别骨关节炎中，仰卧位X线平片足以诊断膝关节骨关节炎。
由于站立位膝关节X线平片具有额外价值，因此在可能的情况下，它比仰卧位膝关节X线平片更受青睐，然而，在某些患者情况下，仰卧位X线平片仍然是可以接受的。
