title: The standing fixed flexion view detects narrowing of the joint space better than the standing extended view in patients with moderate osteoarthritis of the knee.
abstract: OBJECTIVE
  It is unclear whether osteoarthritis (OA) of the knee is seen better in standing flexion position radiographs than in the standing extended view. We assessed the value of standing flexion views.
  
  
  METHODS
  We retrospectively evaluated 1,090 radiographs of 545 consecutive knees with non-traumatic knee pain, comparing standing fixed flexion view (FFV) and standing extended view (SEV). OA was classified according to the Kellgren-Lawrence (KL) radiographic grading scale and joint space widths were measured.
  
  
  RESULTS
  Medial joint space width was lower on average in the FFV, with the greatest difference in KL II knees. Medial full-thickness loss of cartilage was also seen more often in the FFVs of knees with moderate OA (KL II-III) than in the SEVs (6% vs. 19%).
  
  
  CONCLUSIONS
  Using FFV, there is no need to measure the exact knee flexion angle to use fluoroscopy. In earlier studies, the FFV has been found to be reproducible and easy to use in clinical practice. We recommend using flexion views when deciding the appropriate type of intervention in patients with OA. Full-thickness loss of cartilage in particular is better seen in the flexion view, which may be helpful if planning unicompartmental knee arthroplasty.
authors.affiliation: Departments of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland. tuukka.niinimaki@fimnet.fi
authors.forename: Tuukka
authors.initials: T
authors.lastname: Niinimäki
authors.forename: Risto
authors.initials: R
authors.lastname: Ojala
authors.forename: Jaakko
authors.initials: J
authors.lastname: Niinimäki
authors.forename: Juhana
authors.initials: J
authors.lastname: Leppilahti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011187:Posture; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D013314:Stress, Mechanical; D055815:Young Adult
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