Evaluating Glenohumeral Osteoarthritis: The Relative Impact of Patient Age, Activity Level, Symptoms, and Kellgren-Lawrence Grade on Treatment | ||
The Archives of Bone and Joint Surgery | ||
مقاله 8، دوره 7، شماره 2، خرداد و تیر 2019، صفحه 151-160 اصل مقاله (527.67 K) | ||
نوع مقاله: RESEARCH PAPER | ||
شناسه دیجیتال (DOI): 10.22038/abjs.2018.30048.1776 | ||
نویسندگان | ||
Adam Schumaier* 1؛ Joseph Abboud2؛ Brian Grawe1؛ J. Gabriel Horneff2؛ Charles Getz2؛ Gerald Williams2؛ Matthew Ramsey2؛ Surena Namdari2؛ Anthony Romeo3؛ Gregory Nicholson3؛ Jay Keener4؛ Richard Friedman5؛ Ed Yian6؛ Stephanie Muh7؛ Ruth Delaney8؛ Randall Otto9؛ William Levine10؛ JT Tokish11؛ Jack Kazanjian12؛ Joshua Dines13؛ Andrew Green14؛ Scott Paxton14؛ Brody Flanagin15؛ Samer Hasan16؛ Scott Kaar17؛ Anthony Miniaci18؛ Frances Cuomo19 | ||
1University of Cincinnati Department of Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA | ||
2Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA | ||
3Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA | ||
4Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA | ||
5Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA | ||
6Department of Orthopaedics, Southern California Permanente Medical Group, Anaheim, California, USA | ||
7Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA | ||
8University College Dublin, Dublin, Ireland | ||
9Premier Care Orthopaedics and Sports Medicine, St. Louis, Missouri, USA | ||
10Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA | ||
11Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA | ||
12Premier Orthopaedics, Havertown, Pennsylvania, USA | ||
13Hospital for Special Surgery, New York, New York, USA | ||
14Department of Orthopaedic Surgery, Warren-Alpert School of Medicine at Brown University, Providence, Rhode Island | ||
15Orthopaedic Associates of Dallas, Dallas, Texas, USA | ||
16Cincinnati Sports Medicine, Cincinnati, Ohio, USA | ||
17Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA | ||
18Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA | ||
19Department of Orthopaedic Surgery, Montefiore, New York, New York, USA | ||
چکیده | ||
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 decisionmaking 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 subanalysis 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. Level of evidence: III | ||
کلیدواژهها | ||
Clinical decision-making؛ Glenohumeral osteoarthritis؛ Hemiarthroplasty؛ Kellgren-lawrence؛ Patient factors؛ Total shoulder arthroplasty | ||
مراجع | ||
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