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

BACKGROUND AND PURPOSE: 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. PATIENTS AND 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%). INTERPRETATION: 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.