Quality Improvement of X-Ray Imaging for Unspecified Chronic Knee pain and Suspected knee osteoarthritis in the Primary Care Setting

Bever, Ty E

Item

Quality Improvement of X-Ray Imaging for Unspecified Chronic Knee pain and Suspected knee osteoarthritis in the Primary Care Setting

Bever, Ty E

License

http://creativecommons.org/licenses/by/4.0/

Abstract

Although a comprehensive history and physical exam are the mainstays of initial evaluation, plain X-rays are clinically indicated for chronic knee pain of greater than 6 weeks duration and acute traumatic pain in patients who meet specific evidence-based criteria, according to the American Academy of Family Physicians (AAFP). However, there remains significant variation in what radiographic protocols are used in clinical practice, specifically in terms of what radiographic views are ordered and whether the imaging is performed with the patient weight-bearing (WB) or non-weight-bearing (NWB). In fact, several studies have shown that non-weight-bearing knee radiographs are frequently ordered by general practitioners for chronic knee pain and suspected osteoarthritis despite evidence that WB images are more sensitive and accurate in the assessment of joint space narrowing. Therefore, evaluation of chronic knee pain with the use of NWB radiographs has the potential to delay diagnosis and management of early osteoarthritis (OA), lead to less accurate grading of the severity of OA and delay in specialist referral, and contribute to an increase in repeat imaging during specialist consultation.