Evaluating Glenohumeral Osteoarthritis: The Relative Impact of Patient Age, Activity Level, Symptoms, and Kellgren-Lawrence Grade on Treatment
Publish place: The Archives of Bone and Joint Surgery، Vol: 7، Issue: 2
Publish Year: 1398
نوع سند: مقاله ژورنالی
زبان: English
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JR_TABO-7-2_008
تاریخ نمایه سازی: 18 تیر 1398
Abstract:
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
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Authors
Adam Schumaier
University of Cincinnati Department of Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA
Joseph Abboud
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Brian Grawe
University of Cincinnati Department of Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA
J. Gabriel Horneff
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA