ArticleThe Journal of rheumatology2016
Reliability and Accuracy of Cross-sectional Radiographic Assessment of Severe Knee Osteoarthritis: Role of Training and Experience.
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Article in The Journal of rheumatology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial.BMC musculoskeletal disorders · 2022Trial
- Cross-Institutional Five-Class Kellgren-Lawrence Grading of Knee Osteoarthritis via Multitask Deep Learning.Annals of the New York Academy of Sciences · 2026Article
- The Link Between Depression, Analgesia Usage and Function in Osteoarthritis: A Propensity Score-Matched Analysis from the Osteoarthritis Initiative Cohort.Bioengineering (Basel, Switzerland) · 2026Article
- Knee Health Is a Major Determinant of Mobility Across the Healthspan.Journal of functional morphology and kinesiology · 2025Review
- Development and Assessment of the Curtis Thumb Carpometacarpal Osteoarthritis Radiographic Classification.Journal of hand surgery global online · 2025Article
- Optimizing CNN-Based Diagnosis of Knee Osteoarthritis: Enhancing Model Accuracy with CleanLab Relabeling.Diagnostics (Basel, Switzerland) · 2025Article
- Analysis of Risk Factors on Patellofemoral Osteoarthritis: Distribution Characteristics and Radiographic Parameters of Patellofemoral Joint.Orthopaedic surgery · 2024Article
- Survival analysis on subchondral bone length for total knee replacement.Skeletal radiology · 2024Article
- A proposed modification to the Kellgren and Lawrence classification for knee osteoarthritis using a compartment-specific approach.Journal of experimental orthopaedics · 2024Article
- Can bone scintigraphy reflect the progression of osteoarthritis after unicompartmental knee arthroplasty?PloS one · 2023Article
- Deep Learning for Lesion Detection, Progression, and Prediction of Musculoskeletal Disease.Journal of magnetic resonance imaging : JMRI · 2020Review
- Radiographic evaluation of knee osteoarthritis in predicting outcomes after arthroscopic partial meniscectomy.The Knee · 2020Article
- Siamese neural networks for continuous disease severity evaluation and change detection in medical imaging.NPJ digital medicine · 2020Article
- The lateral joint space width can be measured reliably with Telos valgus stress radiography in medial knee osteoarthritis.Skeletal radiology · 2019Article
- Intra-Observer and Inter-Observer Reliability of Shaft Condylar Angle and Lateral Capitellohumeral Angle: Evaluation Based on Reliability in Different Ages and Levels of Experience.Orthopaedic surgery · 2019Article
- Association of MRI findings and expert diagnosis of symptomatic meniscal tear among middle-aged and older adults with knee pain.BMC musculoskeletal disorders · 2016Article
- Association Between Preoperative Radiographic Severity of Osteoarthritis and Patient-Reported Outcomes of Total Knee Replacement.JB & JS open accessArticle
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Authors and funding
7 authors.
Kristina KlaraFrom the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
Jamie E CollinsFrom the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
Ellen GuraryFrom the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
Scott A ElmanFrom the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
Derek S StenquistFrom the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
Elena LosinaFrom the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
Jeffrey N KatzFrom the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School. jnkatz@partners.org.
Funding
Training in Orthopaedic and Musculoskeletal Clinical ResearchT32AR055885 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI KATZ, JEFFREY NEIL, LOSINA, ELENA · 2008 to 2023
$4.0MPatient Oriented Research and Mentoring Program in OrthopedicsK24AR057827 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI LOSINA, ELENA · 2010 to 2019
$1.7MNIAMS NIH HHS K24 AR057827NIAMS NIH HHS T32 AR055885
Abstract
objectiveTo dêtermine the reliability of radiographic assessment of knee osteoarthritis (OA) by nonclinician readers compared to an experienced radiologist.
methodsThe radiologist trained 3 nonclinicians to evaluate radiographic characteristics of knee OA. The radiologist and nonclinicians read preoperative films of 36 patients prior to total knee replacement. Intrareader and interreader reliability were measured using the weighted κ statistic and intraclass correlation coefficient (ICC). Scores κ < 0.20 indicated slight agreement, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 substantial, and 0.81-1.0 almost perfect agreement.
resultsIntrareader reliability among nonclinicians (κ) ranged from 0.40 to 1.0 for individual radiographic features and 0.72 to 1.0 for Kellgren-Lawrence (KL) grade. ICC ranged from 0.89 to 0.98 for the Osteoarthritis Research Society International (OARSI) summary score. Interreader agreement among nonclinicians ranged from κ of 0.45 to 0.94 for individual features, and 0.66 to 0.97 for KL grade. ICC ranged from 0.87 to 0.96 for the OARSI Summary Score. Interreader reliability between nonclinicians and the radiologist ranged from κ of 0.56 to 0.85 for KL grade. ICC ranged from 0.79 to 0.88 for the OARSI Summary Score.
conclusionIntrareader and interreader agreement was variable for individual radiograph features but substantial for summary KL grade and OARSI Summary Score. Investigators face tradeoffs between cost and reader experience. These data suggest that in settings where costs are constrained, trained nonclinicians may be suitable readers of radiographic knee OA, particularly if a summary score (KL grade or OARSI Score) is used to determine radiographic severity.
Indexed as
Clinical CompetenceAgedCross-Sectional StudiesFemaleHumansKnee JointMaleMiddle AgedObserver VariationOsteoarthritis, KneeRadiographic Image Interpretation, Computer-AssistedRadiographyReproducibility of ResultsSensitivity and SpecificityINTERREADER RELIABILITYKNEE OSTEOARTHRITISRADIOGRAPHYRELIABILITY
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