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evaluating glenohumeral osteoarthritis: the relative impact of patient age, activity level, symptoms, and kellgren-lawrence grade on treatment
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نویسنده
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grawe brian ,romeo anthony ,williams gerald ,nicholson gregory ,schumaier adam ,tokish jt ,muh stephanie ,ramsey matthew ,levine william ,friedman richard ,otto randall ,delaney ruth ,dines joshua ,flanagin brody ,namdari surena ,green andrew ,kazanjian jack ,paxton scott ,yian ed ,abboud joseph ,keener jay ,kaar scott ,getz charles ,hasan samer ,cuomo frances ,miniaci anthony ,horneff j. gabriel
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منبع
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the archives of bone and joint surgery - 2019 - دوره : 7 - شماره : 2 - صفحه:151 -160
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چکیده
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Background: it is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. the goals ofthis study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decisionmakingof shoulder specialists and 2) evaluate the observer reliability of the kellgren-lawrence (kl) grading system forprimary osteoarthritis of the shoulder.methods: twenty-six shoulder surgeons were each sent 54 simulated patient cases. each patient had a differentcombination of age, symptoms, activity level, and radiographs. responders graded the radiographs and chose atreatment (non-operative, arthroscopy, hemiarthroplasty, or total shoulder arthroplasty). spearman correlations andchi square tests were used to assess the relationship between factors and treatments. sub-analysis was performedon 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 subanalysisof 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 wasminimal. 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 moststrongly associated with treatment. in operative cases, the factors most strongly associated with the choice of operationwere 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 thisremains a controversial topic.level of evidence: iii
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کلیدواژه
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clinical decision-making ,glenohumeral osteoarthritis ,hemiarthroplasty ,kellgren-lawrence ,patient factors ,total shoulder arthroplasty
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آدرس
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university of cincinnati, department of orthopaedics and sports medicine, usa, rush university medical center, department of orthopaedic surgery, usa, thomas jefferson university, rothman institute, usa, rush university medical center, department of orthopaedic surgery, usa, university of cincinnati, department of orthopaedics and sports medicine, usa, greenville health system, steadman hawkins clinic of the carolinas, usa, henry ford hospital, department of orthopaedic surgery, usa, thomas jefferson university, rothman institute, usa, columbia university medical center, department of orthopaedic surgery, usa, medical university of south carolina, department of orthopaedic surgery, usa, premier care orthopaedics and sports medicine, usa, university college dublin, ireland, hospital for special surgery, usa, orthopaedic associates of dallas, usa, thomas jefferson university, rothman institute, usa, brown university, warren-alpert school of medicine, department of orthopaedic surgery, usa, premier orthopaedics, usa, brown university, warren-alpert school of medicine, department of orthopaedic surgery, usa, southern california permanente medical group, department of orthopaedics, usa, thomas jefferson university, rothman institute, usa, washington university in st. louis, department of orthopaedic surgery, usa, saint louis university, department of orthopaedic surgery, usa, thomas jefferson university, rothman institute, usa, cincinnati sports medicine, usa, montefiore, department of orthopaedic surgery, usa, cleveland clinic, department of orthopaedic surgery, usa, thomas jefferson university, rothman institute, usa
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Authors
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