Adam Schumaier1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Joseph Abboud1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Brian Grawe1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, J Gabriel Horneff1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Charles Getz1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Anthony Romeo1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Jay Keener1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Richard Friedman1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Ed Yian1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Stephanie Muh1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Gregory Nicholson1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Ruth Delaney1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Randall Otto1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, William William1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, J T Tokish1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Gerald Williams1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Jack Kazanjian1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Joshua Dines1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Matthew Ramsey1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Andrew Green1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Scott Paxton1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Surena Namdari1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Brody Flanagin1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Samer Hasan1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Scott Kaar1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Anthony Miniaci1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19, Frances Cuomo1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19. 1. Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. 2. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA. 3. Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA. 4. Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA. 5. Department of Orthopaedics, Southern California Permanente Medical Group, Anaheim, California, USA. 6. Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA. 7. University College Dublin, Dublin, Ireland. 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. Hospital for Special Surgery, New York, New York, USA. 13. Department of Orthopaedic Surgery, Warren-Alpert School of Medicine at Brown University, Providence, Rhode Island. 14. Orthopaedic Associates of Dallas, Dallas, Texas, USA. 15. Cincinnati Sports Medicine, Cincinnati, Ohio, USA. 16. Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA. 17. Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA. 18. Department of Orthopaedic Surgery, Montefiore, New York, New York, USA. 19. Research performed at University of Cincinnati, Department of Orthopaedics and Sports Medicine, Ohio, USA.
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.
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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