Evaluating glenohumeral osteoarthritis: The relative impact of patient age, activity level, symptoms, and Kellgren-Lawrence grade on treatment

Adam Schumaier, Brian Grawe, Joseph Abboud, J. Gabriel Horneff, Charles Getz, Gerald Williams, Matthew Ramsey, Surena Namdari, Anthony Romeo, Gregory Nicholson, Jay Keener, Richard Friedman, Ed Yian, Stephanie Muh, Ruth Delaney, Randall Otto, William Levine, J. T. Tokish, Jack Kazanjian, Joshua DinesAndrew Green, Scott Paxton, Brody Flanagin, Samer Hasan, Scott Kaar, Anthony Miniaci, Frances Cuomo

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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: 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: The significant correlations (P<0.01) were: symptoms [0.46], KL grade [0.44], and age [0.11]. In the sub-analysis of 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 was minimal. 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 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.

Original languageEnglish (US)
Pages (from-to)151-160
Number of pages10
JournalArchives of Bone and Joint Surgery
Volume7
Issue number2
StatePublished - Jan 1 2019
Externally publishedYes

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Osteoarthritis
Therapeutics
Hemiarthroplasty
Arthroscopy
Chi-Square Distribution
Arthroplasty
Decision Making

Keywords

  • Clinical decision-making
  • Glenohumeral osteoarthritis
  • Hemiarthroplasty
  • Kellgren-lawrence
  • Patient factors
  • Total shoulder arthroplasty

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Evaluating glenohumeral osteoarthritis : The relative impact of patient age, activity level, symptoms, and Kellgren-Lawrence grade on treatment. / Schumaier, Adam; Grawe, Brian; Abboud, Joseph; Gabriel Horneff, J.; Getz, Charles; Williams, Gerald; Ramsey, Matthew; Namdari, Surena; Romeo, Anthony; Nicholson, Gregory; Keener, Jay; Friedman, Richard; Yian, Ed; Muh, Stephanie; Delaney, Ruth; Otto, Randall; Levine, William; Tokish, J. T.; Kazanjian, Jack; Dines, Joshua; Green, Andrew; Paxton, Scott; Flanagin, Brody; Hasan, Samer; Kaar, Scott; Miniaci, Anthony; Cuomo, Frances.

In: Archives of Bone and Joint Surgery, Vol. 7, No. 2, 01.01.2019, p. 151-160.

Research output: Contribution to journalArticle

Schumaier, A, Grawe, B, Abboud, J, Gabriel Horneff, J, Getz, C, Williams, G, Ramsey, M, Namdari, S, Romeo, A, Nicholson, G, Keener, J, Friedman, R, Yian, E, Muh, S, Delaney, R, Otto, R, Levine, W, Tokish, JT, Kazanjian, J, Dines, J, Green, A, Paxton, S, Flanagin, B, Hasan, S, Kaar, S, Miniaci, A & Cuomo, F 2019, 'Evaluating glenohumeral osteoarthritis: The relative impact of patient age, activity level, symptoms, and Kellgren-Lawrence grade on treatment', Archives of Bone and Joint Surgery, vol. 7, no. 2, pp. 151-160.
Schumaier, Adam ; Grawe, Brian ; Abboud, Joseph ; Gabriel Horneff, J. ; Getz, Charles ; Williams, Gerald ; Ramsey, Matthew ; Namdari, Surena ; Romeo, Anthony ; Nicholson, Gregory ; Keener, Jay ; Friedman, Richard ; Yian, Ed ; Muh, Stephanie ; Delaney, Ruth ; Otto, Randall ; Levine, William ; Tokish, J. T. ; Kazanjian, Jack ; Dines, Joshua ; Green, Andrew ; Paxton, Scott ; Flanagin, Brody ; Hasan, Samer ; Kaar, Scott ; Miniaci, Anthony ; Cuomo, Frances. / Evaluating glenohumeral osteoarthritis : The relative impact of patient age, activity level, symptoms, and Kellgren-Lawrence grade on treatment. In: Archives of Bone and Joint Surgery. 2019 ; Vol. 7, No. 2. pp. 151-160.
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T2 - The relative impact of patient age, activity level, symptoms, and Kellgren-Lawrence grade on treatment

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AU - Grawe, Brian

AU - Abboud, Joseph

AU - Gabriel Horneff, J.

AU - Getz, Charles

AU - Williams, Gerald

AU - Ramsey, Matthew

AU - Namdari, Surena

AU - Romeo, Anthony

AU - Nicholson, Gregory

AU - Keener, Jay

AU - Friedman, Richard

AU - Yian, Ed

AU - Muh, Stephanie

AU - Delaney, Ruth

AU - Otto, Randall

AU - Levine, William

AU - Tokish, J. T.

AU - Kazanjian, Jack

AU - Dines, Joshua

AU - Green, Andrew

AU - Paxton, Scott

AU - Flanagin, Brody

AU - Hasan, Samer

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AU - Miniaci, Anthony

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N2 - 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: 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: The significant correlations (P<0.01) were: symptoms [0.46], KL grade [0.44], and age [0.11]. In the sub-analysis of 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 was minimal. 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 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.

AB - 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: 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: The significant correlations (P<0.01) were: symptoms [0.46], KL grade [0.44], and age [0.11]. In the sub-analysis of 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 was minimal. 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 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.

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KW - Glenohumeral osteoarthritis

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KW - Kellgren-lawrence

KW - Patient factors

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