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



1 University of Cincinnati Department of Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA

2 Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

3 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

4 Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA

5 Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA

6 Department of Orthopaedics, Southern California Permanente Medical Group, Anaheim, California, USA

7 Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA

8 University College Dublin, Dublin, Ireland

9 Premier Care Orthopaedics and Sports Medicine, St. Louis, Missouri, USA

10 Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA

11 Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA

12 Premier Orthopaedics, Havertown, Pennsylvania, USA

13 Hospital for Special Surgery, New York, New York, USA

14 Department of Orthopaedic Surgery, Warren-Alpert School of Medicine at Brown University, Providence, Rhode Island

15 Orthopaedic Associates of Dallas, Dallas, Texas, USA

16 Cincinnati Sports Medicine, Cincinnati, Ohio, USA

17 Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA

18 Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA

19 Department of Orthopaedic Surgery, Montefiore, New York, New York, USA


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


Main Subjects