X-ray of the knee joint with a load in Moscow: addresses and prices

All radiological examinations must be justified and have goals and diagnostic objectives. The knee is a weight-bearing joint and therefore a weight bearing x-ray of the knee joint is required for most purposes. Since radiographs provide only two-dimensional images of bone structures, to create an idea of three-dimensional structures, images are taken in two planes perpendicular to each other.

As part of a standard knee examination, the doctor may decide whether an X-ray of the knee joint is necessary.

Why are x-rays prescribed?

As you know, MRI is the most optimal method for diagnosing pathologies of the knee joint, but MRI alone does not always allow the doctor to get a complete picture of some knee pathologies.
Many knee problems are best diagnosed with x-rays, and x-rays are often warranted as a first diagnostic step.
X-rays of the knee joint provide much more useful information about the alignment in the knee, allow you to evaluate the structure of the bone tissue and determine the degree of degenerative changes in the knee joint.
Sometimes the doctor may order x-rays of both knees and, as a rule, this is necessary to compare changes in the joints associated with arthrosis.

Three reasons for performing osteoarticular radiography at the Miracle Doctor clinic

Emergency diagnostics You can contact us immediately after receiving an injury. We immediately take a picture, and the doctor issues a conclusion about the nature of the existing damage. We subject the data obtained during radiography to digital processing. If there is a need for consultation with other specialists (surgeons, traumatologists, rheumatologists), we will transmit digital images for review via a local network or the Internet.
Information content When providing qualified assistance (reduction of dislocations, comparison of fractures), monitoring the effectiveness of these measures is important. Therefore, we take images directly at the point of care, in operating rooms, so that the doctor can evaluate the effectiveness of his actions.
Children's diagnostics We conduct research not only for adults, but also for children. The main indications are fractures and dislocations, as well as congenital dysplasia. A special place among them is occupied by hip dysplasia, or congenital dislocation of the hip. Therefore, we have to examine even newborns.

What can be determined with an x-ray?

Your doctor may look for the following in X-rays of your knee:

Soft tissue changes: X-rays are better at visualizing bone tissue, but x-rays can also show soft tissue changes, such as soft tissue swelling and excess fluid in the knee.
Bone quality: X-rays cannot assess bone density, but they can detect various abnormalities, such as thinning bones.
Alignment: X-rays taken in a standing position show the alignment of the knee joint and the presence of bone alignment abnormalities. Poor alignment can place excess stress on parts of the joint and accelerate the development of arthrosis.
Joint spaces: The space between the bones that form a joint is virtually completely filled with cartilage. Narrowing of the joint space, determined on x-ray, is an obvious sign of the degree of development of arthrosis.
Early signs of osteoarthritis: X-rays can reveal early signs of arthritis, including osteophytes.
Trauma/Fracture: X-rays provide objective evidence of damage to the integrity of the bony structures of the knee joint.

Types of X-ray examinations of bones and joints

Depending on the indications and symptoms, the following types of X-ray examinations are performed:

X-ray of the elbow, wrist, knee and hip joints;
X-ray of tubular bones
X-ray of the sternum, collarbone;
X-ray of the hand and foot;
X-ray of the pelvis;
X-ray of the sacroiliac joints.

1 X-ray of the hand using the ITALRAY CLINODIGIT COMPACT device in MedicCity

2 X-ray of the hand in MedicCity using the ITALRAY CLINODIGIT COMPACT device in MedicCity

How is an x-ray performed?

An x-ray of the knee joint taken in a standing position shows the narrowing of the joint space and the position of the knee joint.
An x-ray of the knee at a 45-degree angle shows complete loss of the medial joint space, which may not be obvious when the x-ray is taken in a standing position. This type of imaging allows early degenerative changes in functional position to be detected.
Lateral x-ray of the knee at a 60° angle shows Patellaalta. This position also allows one to see trochleadysplasia.
X-ray of the knee at a 30° angle
Stress radiography is sometimes used as a diagnostic tool to assess knee instability in all directions, but because it only provides two-dimensional (2D) and static images, this method of measuring dynamic knee functionality is limited.
X-ray of passive stress.

Passive stress radiography offers objective, quantifiable, noninvasive, and retrievable data for the diagnosis and evaluation of knee ligament injuries.

Dynamic stereoradiography and fluoroscopy can provide accurate measurements of knee joint kinematics, but their use is limited by high radiation exposure.

X-ray method in the diagnosis of joint diseases

X-ray examination is essential for establishing the diagnosis of the disease and should be used, whenever possible, in every patient with joint damage. In this case, several radiological techniques (methods) can be used: radiography, tomography, X-ray pneumography. X-rays of joints make it possible to determine the condition of not only the osteochondral elements that make up the joint, but also the soft periarticular tissues, which is sometimes important for diagnosis. When performing x-rays of joints, it is mandatory to take a picture of the joint in at least 2 projections (frontal and lateral) and compare the affected and healthy paired joints. Only under these conditions, on the basis of a radiograph, can one reliably judge the condition of the joint [1]. It must be borne in mind that at the initial stage of the disease, radiography does not reveal any pathological symptoms. The earliest radiological sign of inflammatory joint diseases is osteoporosis of the epiphyses of the bones that make up the joint. In the presence of osteoporosis, the spongy substance of the epiphyses appears more transparent on the radiograph, and against its background the contours of the bone, formed by a more dense cortical layer, which in the future may also undergo thinning, stand out sharply. Osteoporosis (both diffuse and focal) develops most often in acute and chronic inflammatory diseases of the joints. With degenerative-dystrophic lesions of the joints in the early stages, osteoporosis is not observed, so this sign may have differential diagnostic value in such cases. In the later stages of arthrosis, moderate osteoporosis may be observed, combined with cystic bone restructuring.

Degenerative-dystrophic forms of joint diseases are characterized by compaction of the bone substance of the subchondral layer of the epiphyses (end plates of the articular surfaces). This compaction develops as the articular cartilage degenerates and its buffering function decreases (as a compensatory phenomenon). With the complete disappearance of cartilage, but with preservation of mobility in the joint, which usually occurs with arthrosis, a more pronounced and more widespread sclerosis of the bone is determined on the x-ray. On the contrary, with loss of joint function, thinning of the subchondral layer of the epiphyses is observed, even with preserved cartilage. An important radiological sign is a change in the X-ray joint space, which mainly reflects the condition of the articular cartilage. Widening of the joint space can be observed with large effusions in the joint cavity or with thickening of the articular cartilage, which occurs, for example, with Perthes disease. Much more often there is a narrowing of the joint space due to degenerative changes, destruction or even complete disappearance of cartilage. A narrowing of the X-ray joint space always indicates a pathology of the articular cartilage. It can occur both in long-term inflammatory and dystrophic lesions of the joints, progressing with the course of the disease, and thus has no differential diagnostic value. Complete disappearance of the joint space is observed in inflammatory diseases in the event of the development of bone ankylosis. During degenerative processes, the joint space never completely disappears.

The condition of the articular surfaces of the epiphyses has significantly greater differential diagnostic significance. Inflammatory diseases of the joints are characterized by destructive changes in the articular surfaces and, above all, the presence of marginal bone defects - the so-called usurs. Uzures are most often located on the lateral parts of the articular surfaces, from where pannus (granulation tissue) “creeps” onto the articular cartilage [2, 3]. In recent years, in the diagnosis of joint lesions, importance has been attached to cystic reorganization of bone tissue, which can be observed in both inflammatory and degenerative processes. Despite some common radiographic signs, each joint disease has its own radiographic picture. There is quite a lot of data in the literature about the possibilities of x-ray diagnosis of osteoarthritis, rheumatoid arthritis (RA) and much less information about the features of the x-ray picture of ankylosing spondylitis (AS), psoriatic arthritis (PA), gout, i.e. those diseases that are often encountered in practice doctors in their daily work [3].

So, AS, or ankylosing spondylitis, is an inflammatory disease that affects the spine, sacroiliac joints and peripheral joints. For radiological examination of patients with suspected AS, it is necessary to perform radiographs of the sacroiliac joint and spine. When examining the sacroiliac joint, it is recommended to take 3 photographs: 1 – in a direct projection and 2 – in an oblique one (right and left, at an angle of 45o). When examining the spine, radiography is required in direct and lateral, and sometimes in oblique projections. Radiological symptoms are the most important and early sign of 2-sided sacroiliitis. At first, one joint may be changed; after a few months, the second one is also involved in the process. The first sign of sacroiliitis is the blurring of the bone edges that form the joint; the joint space appears wider. Later, marginal erosions appear, the contours of the articular surfaces look “eaten away”, uneven, and the joint space narrows. In parallel, periarticular sclerosis develops, followed by ankylosis and obliteration of the joint. In most cases, the characteristic x-ray picture develops only 2 years after the onset of the disease, but sometimes as early as 3–4 months. It is possible to detect early signs of sacroiliitis.

Another important sign is a characteristic lesion of the intervertebral joints - blurring of the articular plates, and then narrowing of the joint space. As a result, ankylosis forms and the joint space is not visible. In this case, there are no marginal osteophytes, the joint space does not change, and neoarthrosis does not form. This sign, in combination with 2-sided symmetrical sacroiliitis, makes it possible to confidently diagnose AS. Characteristic of AS is the formation of bone bridges (syndesmophytes) between adjacent vertebrae due to ossification of the peripheral parts of the intervertebral discs. First of all, they arise at the border of the thoracic and lumbar spine on the lateral surface. With the widespread formation of syndesmophytes in all parts of the spine, the “bamboo stick” symptom appears. Less specific radiological signs of spinal damage in AS include: – the formation of erosions at the junction of the fibrous ring with the vertebra, especially in the anterior sections; – square shape of the vertebra (on the lateral radiograph); – ossification of the longitudinal ligaments, which appears on the radiograph in the frontal projection in the form of longitudinal strips, and in the lateral projection the ossification of the anterior longitudinal ligament is clearly noticeable; – vertebral ankylosis, which, as a rule, forms first in the anterior parts of the spine (Fig. 1). Involvement of the hip and knee joints in the process is manifested by a narrowing of the joint space; erosions are rarely detected. The joints of the hands and feet are very rarely affected. X-rays reveal erosions that are very similar to those in RA, but osteoporosis is mild, and the changes are often asymmetrical. Erosion and sclerosis can be detected in the sternocostal and sternoclavicular joints, and ankylosis can sometimes be observed in the pubic symphysis. With a prolonged course in the area of the wings of the pelvic bones and on the ischial tuberosities, small exostoses can be identified - “spiny pelvis”. Thus, during AS, the following radiological stages can be distinguished: a) radiological signs of the disease are not visible on a traditional radiograph; b) signs of sacroiliitis are revealed, i.e., blurring of the subchondral layer of the joints is noted; initially a slight expansion, and then a narrowing of the joint space; signs of formation of erosions and osteophytes appear in the joints of the spine; c) ankylosis of the sacroiliac joints and the “bamboo stick” symptom; joint spaces in the intervertebral joints are not visible; signs of osteoporosis; d) the spine has the appearance of a tubular bone, the discs and all ligaments ossify, and bone atrophy occurs [4–7]. PA is a fairly common disease of the musculoskeletal system, combined with skin lesions of psoriasis. The X-ray picture of PA has a number of features. Thus, osteoporosis, characteristic of many joint diseases, in PA is clearly observed only at the onset of the disease and in the mutilating form. Radiological manifestations of arthritis of the distal interphalangeal joints are quite typical. This is an erosive asymmetric process, in which proliferative changes are simultaneously detected in the form of bone growths at the bases and tips of the phalanges, periostitis.

Erosion, having arisen at the edges of the joint, subsequently spreads to its center. In this case, the apices of the terminal and middle phalanges are worn down with simultaneous thinning of the diaphyses of the middle phalanges, and the second articular surface is deformed in the form of a concavity, which creates the radiological symptom “pencils in a glass”, or “cup and saucer”. Characterized by the proliferation of bone tissue around erosions and osteolysis of the distal phalanges. One bone is often pushed into another like a telescope (“telescopic” finger). In polyarthritis that occurs without damage to the end joints, the x-ray picture may resemble RA with marginal erosions of the epiphyses and bone ankylosis of the joints, however, the development of ankylosing process in several joints of the same finger is considered pathognomonic for PA.

The mutating form of PA, as mentioned above, is manifested by severe osteolytic changes in the constituent joints of the bones. Not only the epiphyses, but also the diaphyses of the bones of the joints involved in the pathological process are subject to resorption. Sometimes the lesion affects not only all the joints of the hands and feet, but also the diaphyses of the bones of the forearm (Fig. 2). X-ray changes in the spine in patients with PA include: – vertebral osteoporosis; – paraspinal ossifications; – ankylosis and erosion of intervertebral joints; – deformation of the vertebrae; – syndesmophytes; – reduction in the height of intervertebral discs; – multiple osteophytosis (lateral, anterior, posterior angles of the vertebrae); – sharpening and elongation of the edges of the uncovertebral joints; - Schmorl's hernia. Damage to the spine and sacroiliac joints during radiographic examination can be detected in 57% of patients, most of whom have no clinical signs of sacroiliitis and spondyloarthritis. In other words, spondyloarthritis occurs latently, which must be kept in mind when examining the patient. Sacroiliitis is most often 1-sided, although a 2-sided symmetrical process with ankylosis of the sacroiliac joints is also observed, as in true AS. Thus, radiological signs that help to distinguish PA from other inflammatory rheumatic diseases of the joints are as follows: – asymmetry of damage to the joints of the hands; – arthritis on radiographs may be without periarticular osteoporosis; – isolated damage to the distal interphalangeal joints of the hands with no changes or slight changes in other small joints of the hands; – axial damage to 3 joints of one finger; – transverse lesion of the joints of the hands at the same level (1- or 2-sided); – destruction of the terminal phalanges (acroosteolysis); – terminal narrowing (atrophy) of the distal epiphyses of the phalanges of the fingers and metacarpal bones; – cup-shaped deformation of the proximal part of the phalanges of the fingers together with the terminal narrowing of the distal epiphyses – the “pencil in a glass” symptom; – bone ankylosis, especially of the proximal and distal interphalangeal joints of the hands; – multiple intra-articular osteolysis and destruction of the epiphyses of bones with multidirectional deformations of the joints (arthritis mutilans); – inflammatory changes in the sacroiliac joints – sacroiliitis (usually unilateral asymmetrical or bilateral, perhaps the absence of sacroiliitis); – changes in the spine (asymmetric syndesmophytes, paravertebral ossifications) [8, 9]. Gout is a systemic disease associated with impaired purine metabolism, deposition of urate in articular and/or periarticular tissues and inflammation developing in connection with this. In acute arthritis, specific changes are not detected on radiographs. X-ray changes characteristic of gout usually develop no earlier than 3 years from the onset of the disease. At the same time, signs of destruction, degeneration and regeneration can be observed.

Gout is characterized by intraosseous cyst-like formations of various sizes, caused by tophi, which can be located inside the joint, but, what is especially noteworthy, next to it and even at some distance. Chronic gouty arthritis may be accompanied by cartilage destruction (narrowing of the joint space) and the development of marginal bone erosions. The so-called “piercer symptom” - marginal bone erosions or cyst-like formations of regular shape with clear, sometimes sclerotic contours - is rarely observed in gout and is not specific for it. More typical for this disease is the pronounced destruction that occurs over time not only of the subchondral portion of the bone, but also of the entire epiphysis and even part of the diaphysis (intra-articular osteolysis). In this case, a significant expansion of the “eaten away” articular parts of the bones and a sharpening of their edges can be observed. Bone ankylosis in gout has been described, but is extremely rare (Fig. 3).

The localization of radiological changes is always peculiar in gout. Typically, the most pronounced pathology is found in the joints of the feet (primarily in the joints of the big toes) and hands. Rare but known sites of radiological changes in gout include the shoulder, hip, sacroiliac joints and spine. It is important to note that destructive joint changes or intraosseous cysts are considered a sign of “tophus” gout.

Bone changes in gout rarely decrease with specific therapy; over time, they may even increase slightly. Tophi located in soft tissue can also be detected by radiography, especially if they are calcified, which is uncommon [1, 3].

Thus, in the diagnosis of joint diseases, without a doubt, the x-ray method should be used, especially in the daily practice of a primary care doctor, since each of the diseases has its own x-ray signs characteristic only of it. Knowledge of the features of the X-ray picture of arthritis can certainly help the practitioner in making the correct diagnosis.

Literature 1. Nasonov E.L. Clinical recommendations. Rheumatology. M.: GEOTAR-Media, 2008. 2. Kishkovsky A.N., Tyutin L.A., Esinovskaya G.N. Atlas of placements for X-ray examinations. L.: Medicine, 1987. 3. Lindenbraten L.D., Korolyuk I.P. Medical radiology (basics of radiation diagnostics and radiation therapy). 2nd ed., revised. and additional M.: Medicine, 2000. 4. Agababova E.R. Differential diagnosis of seronegative arthritis // Ter. archive. 1986. T. 58. No. 7. P. 149. 5. Zedgenidze G.A. Clinical radiology. M., 1984. 6. Nasonova V.A., Astapenko M.G. Clinical rheumatology. M., 1989. 7. Sidelnikova S.M. Questions of pathogenesis, diagnosis and differential diagnosis of seronegative spondyloarthritis // Ter. archive. 1986. T. 58. No. 6. P. 148. 8. Badokin V.V. Rheumatology. M.: Litterra, 2012. 9. Molochkov V.A., Badokin V.V., Albanova V.I. and others. Psoriasis and psoriatic arthritis. M.: Partnership of Scientific Publications KMK; Authors' Academy, 2007.

Who is recommended to undergo radiography?

For people in certain professions (long-distance carrier, for example), x-rays are recommended at least twice a year. Patients with diabetes, tuberculosis, and rehabilitation patients (with long-term physical inactivity) require x-rays more often (the schedule is set by the doctor).

For others, the indications for the procedure are:

strange sensations (painful or restraining) in the area of the movable ligaments;
decreased joint mobility;
change in skin color (blueness, pallor) in the area of the joints;
injuries to the arms, legs, head;
swelling (x-ray of ankles, knees);
visually noticeable deformation.

X-rays of joints are performed to monitor treatment

, research into the effectiveness of rehabilitation physical therapy and other purposes. There are few contraindications: pregnancy and diseases of the central nervous system/psyche, in which a person cannot control his mobility.

How is the diagnosis carried out?

The technologist positions the patient on the table, places a flat cassette under the table in the area that will be imaged.
During a chest x-ray, the patient usually stands with his chest pressed against the photographic plate.
The technologist will ask the patient to remain still and not move for a while.
The radiography equipment is activated by sending a beam of x-rays through the body onto a special plate to record a digital image. For a chest x-ray, the patient will be asked to take a deep breath and hold it. This not only reduces the possibility of image blur, but also improves its quality.
Once the image is taken, you will be asked to wait while the radiologist develops and examines the images.
X-rays are painless and last about 5-10 minutes.

Preparing for X-rays

There is no special preparation for bone x-rays. You may need to change into special clothing and remove jewelry, dentures, glasses, and any metal objects that might distort the X-ray images. Women should always inform their doctor or x-ray technologist if there is a possibility that they are pregnant. Before starting the procedure, the area that should not be imaged, but may fall into the radiation field, is covered with a lead apron. You should also tell your doctor if you have metal implants from previous surgeries, such as a heart valve or pacemaker.

What is it - X-ray examination of the joint apparatus

For this reason, x-rays can also be prescribed for newborns if there is a reason (the child is completely covered with a protective apron, only the area of examination remains open). The latter determines the type of x-ray. Depending on the location of the symptoms, it may be:

ankle joint system;
elbow and/or shoulder joints;
photo of the hip ligament system;
VChS;
knee apparatus.

The procedure is performed quickly and without pain (2-5 minutes, maximum 10). There is no need to prepare for x-rays of joints. The main condition for success is freezing/immobility for several seconds. to obtain the most accurate image possible.

Diagnosed pathology

An X-ray of the pelvis will reveal a large number of pathological conditions of the hip joint. These include inflammatory processes, traumatic injuries, and much more.

Hip fractures of various locations

Using an x-ray, which can be taken in different projections, it will be possible to determine the presence of violations of the integrity of the bones. These include fractures of the femoral neck, head of the joint, or proximal bone.

Dislocations and subluxations in the joint

An x-ray of the pelvic bones can determine the position of the head of the hip joint. Such data will allow us to make a conclusion about the presence of dislocation or subluxation.

Changes in articular surfaces, pathology of the hip joint (arthritis, arthrosis)

Such changes are characterized by joint deformations and changes in the structure of bone and cartilage tissue. Arthritis is an inflammatory disease that gradually affects all joint structures and causes a person great discomfort. Arthrosis consists of deformations, limited mobility and destruction of cartilage tissue. If you have complaints, it is best to find out how x-rays of the hip joints are taken and undergo an examination. Timely treatment will eliminate inflammation and stop degenerative processes.

Hip dysplasia, congenital malformation

X-rays of the hip joints must be taken to confirm the diagnosis and identify dysplasia, which is often congenital. This condition provokes preluxation, and then subluxation and dislocation. Movement in such a situation becomes extremely painful and uncomfortable for a person. The resulting images allow us to assess the position of the articular head, its size as a whole and relative to the acetabulum.

Perthes disease

It is an osteochondropathy of the femur. This process is characterized by the death of the femoral head; the disease is non-infectious. Children are most often affected; the disease develops between the ages of 4 and 14 years. Boys are several times more susceptible to Perthes disease than girls. If there is any suspicion of this disease, an x-ray of the hip joint should be taken immediately.

With such a disease, the joint goes through five stages: aseptic necrosis, then a secondary compression fracture, after which the remnants of dead spongy substance resolve, recovery occurs and the stage of secondary changes begins. The earlier the disease is detected, the more optimistic the prognosis is; at the second and third stages, the child is already eligible for surgical treatment.