A parallel approach: the impact of schuss radiography of the degenerate knee on clinical management.
Schuss radiographs are PA weight bearing views of the knee taken in 30 degrees of flexion. Several studies have shown them to be more sensitive detectors of osteoarthritic changes in the knee than standard extension AP views. We compared the plans of management proposed by eight consultant orthopaedic surgeons to two case presentations of each of a series of 50 patients with tibiofemoral osteoarthritis. The clinical and radiological information provided on each patient was identical in the two presentations except that on one occasion the surgeons were shown the extension AP radiograph while on the other it was replaced by the schuss view. The panel altered their management plan in over 40% of cases. This represented a reduction of almost 50% in arthroscopies in the schuss group with a move towards definitive surgery. The total number of procedures proposed was also reduced. The radiograph was useful determining the management of patients with predominantly lateral, as well as medial or generalised symptoms. We conclude that the schuss radiograph is a valuable tool in the assessment of knee osteoarthritis the use of which can alter clinical management. By reducing non-therapeutic arthroscopies it may significantly reduce total number of operations to be performed in this patient group.