Evidence-based practice in the utilization of knee radiographs--a survey of all members of the British Orthopaedic Association

Abstract

There has been a debate amongst orthopaedic surgeons about which plain radiographs are required in common knee conditions and this is a 5-year review assessing the influence of recent publications on the use of radiographs. A postal survey of all members of the British Orthopaedic Association was performed. The response rate was 60% (990/1,650). There was a broad agreement on the use of anteroposterior and lateral radiographs. The use of the posteroanterior (PA) weight-bearing radiograph has increased from 82 to 86%. The use of skyline view for suspected arthritis and after knee replacement has increased from 23 to 41%. There is still disparity amongst orthopaedic surgeons regarding the knee flexion angle for skyline and weight-bearing views. After review of the literature we recommend that a single skyline view in 30 degrees flexion is adequate and should be a standard investigation in knee disorders. We also stress the importance of weight-bearing PA radiograph in 30 degrees knee flexion for adequate assessment in all patients with suspected arthritis.

Fig. 1

Angle of knee flexion used by surgeons requesting skyline X-ray at one angle of flexion (n=538)