Patients Age is a critical Factor in determining the Severity of Osteoarthritis of the Shoulder

Abstract

Background: Osteoarthritis (OA) is one of the most common musculoskeletal disorders in the aging population. The correlation of radiographic OA severity, disability and pain is variable and inconsistent for the different joints. This study aims to elucidate the relationship between histological and radiological signs of shoulder OA with pain sensation and functional impairment to potentially adapt the recommendation for surgical treatment for primary total shoulder arthroplasty (TSA). Methods: Forty-four patients with shoulder OA undergoing TSA using an anatomic stemless implant were included in this study. The radiological OA severity was scored preoperatively on true ap X-rays according to the Kellgren-Lawrence-Score (KL-Score). Acromial types according to Bigliani were defined by preoperative radiological images. The histological OA severity was determined according to the OARSI-Score using bone-cartilage sections from loaded areas of the humeral head. Pain was quantified using the Visual Analog Scale (VAS). The functional status was assessed by the items “mobility” and “strength” out of the Constant-Murley-Score (CS-Score). Demographic data including BMI, age, gender, diabetes mellitus and smoking were recorded. Results: There was no correlation between radiographic and histological severity in shoulder OA. However, a correlation of age and the severity of radiological changes was observed. Further, pain did not correlate with histological or radiological scores, whereas it correlated with age and the presence of diabetes mellitus. The functional shoulder status (mobility, strength) correlated with the severity of radiological changes, but not with the histologic scoring, which correlated with nicotine abuse. Conclusion: This study shows that increased age is the main determinant of radiological changes in shoulder OA, as well as pain. Therefore, age and pain sensation should be considered as important parameters for the recommendation for TSA.