Evaluating Glenohumeral Osteoarthritis: The Relative Impact of Patient Age, Activity Level, Symptoms, and Kellgren-Lawrence Grade on Treatment.
Clinical decision-making
Glenohumeral osteoarthritis
Hemiarthroplasty
Kellgren-lawrence
Patient factors
Total shoulder arthroplasty
Journal
The archives of bone and joint surgery
ISSN: 2345-4644
Titre abrégé: Arch Bone Jt Surg
Pays: Iran
ID NLM: 101636743
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
entrez:
19
6
2019
pubmed:
19
6
2019
medline:
19
6
2019
Statut:
ppublish
Résumé
It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals of this study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decision-making of shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system for primary osteoarthritis of the shoulder. Twenty-six shoulder surgeons were each sent 54 simulated patient cases. Each patient had a different combination of age, symptoms, activity level, and radiographs. Responders graded the radiographs and chose a treatment (non-operative, arthroscopy, hemiarthroplasty, or total shoulder arthroplasty). Spearman correlations and chi square tests were used to assess the relationship between factors and treatments. Sub-analysis was performed on surgical cases. An intra-class correlation (ICC) was used to assess observer agreement. The significant correlations ( When evaluating glenohumeral osteoarthritis, patient symptoms and KL grade are the factors most strongly associated with treatment. In operative cases, the factors most strongly associated with the choice of operation were 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 this remains a controversial topic.
Sections du résumé
BACKGROUND
BACKGROUND
It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals of this study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decision-making of shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system for primary osteoarthritis of the shoulder.
METHODS
METHODS
Twenty-six shoulder surgeons were each sent 54 simulated patient cases. Each patient had a different combination of age, symptoms, activity level, and radiographs. Responders graded the radiographs and chose a treatment (non-operative, arthroscopy, hemiarthroplasty, or total shoulder arthroplasty). Spearman correlations and chi square tests were used to assess the relationship between factors and treatments. Sub-analysis was performed on surgical cases. An intra-class correlation (ICC) was used to assess observer agreement.
RESULTS
RESULTS
The significant correlations (
CONCLUSION
CONCLUSIONS
When evaluating glenohumeral osteoarthritis, patient symptoms and KL grade are the factors most strongly associated with treatment. In operative cases, the factors most strongly associated with the choice of operation were 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 this remains a controversial topic.
Types de publication
Journal Article
Langues
eng
Pagination
151-160Références
Arthroscopy. 2000 Jul-Aug;16(5):471-6
pubmed: 10882441
J Shoulder Elbow Surg. 2002 Jan-Feb;11(1):25-32
pubmed: 11845145
J Shoulder Elbow Surg. 2002 Jul-Aug;11(4):299-304
pubmed: 12195244
Ann Rheum Dis. 1957 Dec;16(4):494-502
pubmed: 13498604
Radiol Clin North Am. 2004 Jan;42(1):11-41, v
pubmed: 15049521
J Shoulder Elbow Surg. 2004 Nov-Dec;13(6):599-603
pubmed: 15570227
J Bone Joint Surg Am. 2005 Sep;87(9):1947-56
pubmed: 16140808
Clin Orthop Relat Res. 1992 Feb;(275):152-60
pubmed: 1735206
J Shoulder Elbow Surg. 2007 Jul-Aug;16(4):396-402
pubmed: 17582789
Clin Orthop Relat Res. 2008 Mar;466(3):634-8
pubmed: 18264851
Br J Hosp Med (Lond). 2008 May;69(5):264-8
pubmed: 18557547
J Shoulder Elbow Surg. 2010 Jan;19(1):143-50
pubmed: 19556148
Psychol Bull. 1992 Jul;112(1):155-9
pubmed: 19565683
Arthroscopy. 2010 Nov;26(11):1451-5
pubmed: 20875718
J Bone Joint Surg Am. 2011 May 4;93(9):885-92
pubmed: 21543679
Bone. 2012 Aug;51(2):278-88
pubmed: 22155587
J Shoulder Elbow Surg. 2012 Apr;21(4):561-6
pubmed: 22424421
J Shoulder Elbow Surg. 2013 Aug;22(8):1063-7
pubmed: 23375877
Arthroscopy. 2013 Mar;29(3):440-8
pubmed: 23544687
Am J Sports Med. 2013 Aug;41(8):1900-8
pubmed: 23775244
Int J Shoulder Surg. 2013 Oct;7(4):143-8
pubmed: 24403762
Osteoarthritis Cartilage. 2015 Mar;23(3):363-9
pubmed: 25463444
J Shoulder Elbow Surg. 2015 Feb;24(2):317-25
pubmed: 25487897
Osteoarthritis Cartilage. 2015 Mar;23(3):391-6
pubmed: 25535863
Arthroscopy. 2015 Jun;31(6):1156-1166.e8
pubmed: 25543246
Arthroscopy. 2015 Jun;31(6):1167-8
pubmed: 26048766
Clin Orthop Relat Res. 2015 Oct;473(10):3307-14
pubmed: 26162413
Arch Bone Jt Surg. 2015 Oct;3(4):286-90
pubmed: 26550595
Int J Shoulder Surg. 2015 Oct-Dec;9(4):121-7
pubmed: 26622128
Clin Orthop Relat Res. 2016 Aug;474(8):1886-93
pubmed: 26872913
Int J Shoulder Surg. 2016 Jan-Mar;10(1):28-36
pubmed: 26980987
Clin Orthop Relat Res. 2016 Nov;474(11):2482-2492
pubmed: 27457626
Semin Arthritis Rheum. 2016 Dec;46(3):259-260
pubmed: 27519477
Am J Orthop (Belle Mead NJ). 2016 Jul-Aug;45(5):E273-82
pubmed: 27552465
Am J Sports Med. 2017 Mar;45(4):794-802
pubmed: 27836903
Acta Orthop. 2017 Jun;88(3):310-314
pubmed: 28121220
J Shoulder Elbow Surg. 2017 Jul;26(7):1298-1306
pubmed: 28209327
Am J Sports Med. 2017 Jun;45(7):1664-1669
pubmed: 28319426
Bone Joint J. 2017 Jul;99-B(7):939-943
pubmed: 28663401
J Bone Joint Surg Am. 2017 Aug 2;99(15):1291-1304
pubmed: 28763415
J Am Acad Orthop Surg. 2017 Oct;25(10):715-723
pubmed: 28953086
J Bone Joint Surg Br. 1986 Mar;68(2):201-7
pubmed: 3958003
J Bone Joint Surg Am. 1983 Apr;65(4):456-60
pubmed: 6833319
J Bone Joint Surg Am. 1998 Apr;80(4):464-73
pubmed: 9563375
Arthritis Rheum. 1998 May;41(5):778-99
pubmed: 9588729
J Bone Joint Surg Am. 1998 Jun;80(6):841-52
pubmed: 9655102
J Bone Joint Surg Am. 1998 Jun;80(6):860-7
pubmed: 9655104
Acta Orthop Belg. 1998;64 Suppl 2:46-52
pubmed: 9922529