Evaluating Glenohumeral Osteoarthritis: The Relative Impact of Patient Age, Activity Level, Symptoms, and Kellgren-Lawrence Grade on Treatment
نویسندگان
1 University of Cincinnati Department of Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA
2 Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
3 University of Cincinnati Department of Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA
4 Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
5 Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
6 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
7 Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
8 Premier Care Orthopaedics and Sports Medicine, St. Louis, Missouri, USA
9 Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
10 Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
11 Premier Orthopaedics, Havertown, Pennsylvania, USA
12 Cincinnati Sports Medicine, Cincinnati, Ohio, USA
13 Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA
14 Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
15 Department of Orthopaedic Surgery, Montefiore, New York, New York, USA
16 Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
17 Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
18 Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
19 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
20 Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
21 Department of Orthopaedics, Southern California Permanente Medical Group, Anaheim, California, USA
22 Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
23 University College Dublin, Dublin, Ireland
24 Hospital for Special Surgery, New York, New York, USA
25 Department of Orthopaedic Surgery, Warren-Alpert School of Medicine at Brown University, Providence, Rhode Island
26 Department of Orthopaedic Surgery, Warren-Alpert School of Medicine at Brown University, Providence, Rhode Island
27 Orthopaedic Associates of Dallas, Dallas, Texas, USA
doi
10.22038/abjs.2018.30048.1776چکیده
Background: It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals ofthis study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decisionmakingof shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system forprimary osteoarthritis of the shoulder.Methods: Twenty-six shoulder surgeons were each sent 54 simulated patient cases. Each patient had a differentcombination of age, symptoms, activity level, and radiographs. Responders graded the radiographs and chose atreatment (non-operative, arthroscopy, hemiarthroplasty, or total shoulder arthroplasty). Spearman correlations andchi square tests were used to assess the relationship between factors and treatments. Sub-analysis was performedon surgical cases. An intra-class correlation (ICC) was used to assess observer agreement.Results: The significant correlations (P<0.01) were: symptoms [0.46], KL grade [0.44], and age [0.11]. In the subanalysisof operative cases, the significant correlations were: KL grade [0.64], age [0.39], and activity level [-0.10].The chi square analysis was significant (P<0.01) for all factors, but the practical significance of activity level wasminimal. The ICCs were [inter](intra): KL [0.79] (0.84), patient management [0.54].Conclusion: When evaluating glenohumeral osteoarthritis, patient symptoms and KL grade are the factors moststrongly associated with treatment. In operative cases, the factors most strongly associated with the choice of operationwere the patient’s KL grade and age. Additionally, the KL classification demonstrated excellent observer reliability.However, there was only moderate agreement among shoulder specialists regarding treatment, indicating that thisremains a controversial topic.Level of evidence: III
