Document Type: RESEARCH PAPER
University of Cincinnati Department of Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Department of Orthopaedics, Southern California Permanente Medical Group, Anaheim, California, USA
Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
University College Dublin, Dublin, Ireland
Premier Care Orthopaedics and Sports Medicine, St. Louis, Missouri, USA
Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
Premier Orthopaedics, Havertown, Pennsylvania, USA
Hospital for Special Surgery, New York, New York, USA
Department of Orthopaedic Surgery, Warren-Alpert School of Medicine at Brown University, Providence, Rhode Island
Orthopaedic Associates of Dallas, Dallas, Texas, USA
Cincinnati Sports Medicine, Cincinnati, Ohio, USA
Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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