Evaluating Glenohumeral Osteoarthritis: The Relative Impact of Patient Age, Activity Level, Symptoms, and Kellgren-Lawrence Grade on Treatment

Abstract

Background: It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals of<br />this study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decisionmaking<br />of shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system for<br />primary osteoarthritis of the shoulder.<br />Methods: Twenty-six shoulder surgeons were each sent 54 simulated patient cases. Each patient had a different<br />combination of age, symptoms, activity level, and radiographs. Responders graded the radiographs and chose a<br />treatment (non-operative, arthroscopy, hemiarthroplasty, or total shoulder arthroplasty). Spearman correlations and<br />chi square tests were used to assess the relationship between factors and treatments. Sub-analysis was performed<br />on surgical cases. An intra-class correlation (ICC) was used to assess observer agreement.<br />Results: The significant correlations (P<0.01) were: symptoms [0.46], KL grade [0.44], and age [0.11]. In the subanalysis<br />of operative cases, the significant correlations were: KL grade [0.64], age [0.39], and activity level [-0.10].<br />The chi square analysis was significant (P<0.01) for all factors, but the practical significance of activity level was<br />minimal. The ICCs were [inter](intra): KL [0.79] (0.84), patient management [0.54].<br />Conclusion: When evaluating glenohumeral osteoarthritis, patient symptoms and KL grade are the factors most<br />strongly associated with treatment. In operative cases, the factors most strongly associated with the choice of operation<br />were the patient's KL grade and age. Additionally, the KL classification demonstrated excellent observer reliability.<br />However, there was only moderate agreement among shoulder specialists regarding treatment, indicating that this<br />remains a controversial topic.<br />Level of evidence: III