Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections

  • Dhruv S. Shankar (Department of Orthopedic Surgery, New York University Langone Health) ;
  • Edward S. Mojica (Department of Orthopedic Surgery, New York University Langone Health) ;
  • Christopher A. Colasanti (Department of Orthopedic Surgery, New York University Langone Health) ;
  • Anna M. Blaeser (Department of Orthopedic Surgery, New York University Langone Health) ;
  • Paola F. Ortega (Department of Orthopedic Surgery, New York University Langone Health) ;
  • Guillem Gonzalez-Lomas (Department of Orthopedic Surgery, New York University Langone Health) ;
  • Laith M. Jazrawi (Department of Orthopedic Surgery, New York University Langone Health)
  • Received : 2022.07.18
  • Accepted : 2022.12.25
  • Published : 2023.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. Methods: We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05. Results: The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00-1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05-2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80-0.95; P=0.003). Conclusions: There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

Keywords

References

  1. Bell SN, Christmas MU, Coghlan JA. Proximal humeral osteolysis and glenoid radiolucent lines in an anatomic shoulder arthroplasty: a comparison of a ceramic and a metal humeral head component. J Shoulder Elbow Surg 2020;29:913-23.  https://doi.org/10.1016/j.jse.2019.09.032
  2. Grey SG, Wright TW, Flurin PH, Zuckerman JD, Roche CP, Friedman RJ. Clinical and radiographic outcomes with a posteriorly augmented glenoid for Walch B glenoids in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2020;29:e185-95.  https://doi.org/10.1016/j.jse.2019.10.008
  3. Norris TR, Iannotti JP. Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. J Shoulder Elbow Surg 2002;11:130-5.  https://doi.org/10.1067/mse.2002.121146
  4. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am 2011;93:2249-54.  https://doi.org/10.2106/JBJS.J.01994
  5. Guo JJ, Wu K, Guan H, et al. Three-year follow-up of conservative treatments of shoulder osteoarthritis in older patients. Orthopedics 2016;39:e634-41.  https://doi.org/10.3928/01477447-20160606-02
  6. Wang C, Zhang Z, Ma Y, Liu X, Zhu Q. Platelet-rich plasma injection vs corticosteroid injection for conservative treatment of rotator cuff lesions: a systematic review and meta-analysis. Medicine (Baltimore) 2021;100:e24680. 
  7. Giovannetti de Sanctis E, Franceschetti E, De Dona F, Palumbo A, Paciotti M, Franceschi F. The efficacy of injections for partial rotator cuff tears: a systematic review. J Clin Med;2020 10:51. 
  8. Steuri R, Sattelmayer M, Elsig S, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med 2017;51:1340-7.  https://doi.org/10.1136/bjsports-2016-096515
  9. Walch G, Ascani C, Boulahia A, Nove-Josserand L, Edwards TB. Static posterior subluxation of the humeral head: an unrecognized entity responsible for glenohumeral osteoarthritis in the young adult. J Shoulder Elbow Surg 2002;11:309-14.  https://doi.org/10.1067/mse.2002.124547
  10. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears: a long-term observation. Clin Orthop Relat Res 1990;(254):92-6. 
  11. Ansok CB, Muh SJ. Optimal management of glenohumeral osteoarthritis. Orthop Res Rev 2018;10:9-18.  https://doi.org/10.2147/ORR.S134732
  12. Gross C, Dhawan A, Harwood D, Gochanour E, Romeo A. Glenohumeral joint injections: a review. Sports Health 2013;5:153-9.  https://doi.org/10.1177/1941738112459706
  13. Tang A, Almetwali O, Zak SG, Bernstein JA, Schwarzkopf R, Aggarwal VK. Do preoperative intra-articular corticosteroid and hyaluronic acid injections affect time to total joint arthroplasty. J Clin Orthop Trauma 2021;16:49-57.  https://doi.org/10.1016/j.jcot.2020.12.016
  14. Metzger CM, Farooq H, Merrell GA, et al. Efficacy of a single, image-guided corticosteroid injection for glenohumeral arthritis. J Shoulder Elbow Surg 2021;30:1128-34.  https://doi.org/10.1016/j.jse.2020.08.008
  15. Merolla G, Sperling JW, Paladini P, Porcellini G. Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial. Musculoskelet Surg 2011;95:215-24.  https://doi.org/10.1007/s12306-011-0138-3
  16. Forsythe B, Agarwalla A, Puzzitiello RN, Sumner S, Romeo AA, Mascarenhas R. The timing of injections prior to arthroscopic rotator cuff repair impacts the risk of surgical site infection. J Bone Joint Surg Am 2019;101:682-7.  https://doi.org/10.2106/JBJS.18.00631
  17. Kew ME, Cancienne JM, Christensen JE, Werner BC. The timing of corticosteroid injections after arthroscopic shoulder procedures affects postoperative infection risk. Am J Sports Med 2019;47:915-21.  https://doi.org/10.1177/0363546518825348
  18. Rashid A, Kalson N, Jiwa N, Patel A, Irwin A, Corner T. The effects of pre-operative intra-articular glenohumeral corticosteroid injection on infective complications after shoulder arthroplasty. Shoulder Elbow 2015;7:154-6.  https://doi.org/10.1177/1758573214557149
  19. Bhattacharjee S, Wallace S, Luu HH, Shi LL, Lee MJ, Chen AF. Do we need to wait 3 months after corticosteroid injections to reduce the risk of infection after total knee arthroplasty. J Am Acad Orthop Surg 2021;29:e714-21.  https://doi.org/10.5435/JAAOS-D-20-00850
  20. Feeley BT, Gallo RA, Craig EV. Cuff tear arthropathy: current trends in diagnosis and surgical management. J Shoulder Elbow Surg 2009;18:484-94.  https://doi.org/10.1016/j.jse.2008.11.003
  21. Chalmers PN, Salazar DH, Steger-May K, et al. Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears. J Shoulder Elbow Surg 2016;25:1749-55.  https://doi.org/10.1016/j.jse.2016.07.022
  22. Jensen AR, Tangtiphaiboontana J, Marigi E, Mallett KE, Sperling JW, Sanchez-Sotelo J. Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly. J Shoulder Elbow Surg 2021;30:S131-9.  https://doi.org/10.1016/j.jse.2020.11.030
  23. Menge TJ, Boykin RE, Byram IR, Bushnell BD. A comprehensive approach to glenohumeral arthritis. South Med J 2014;107:567-73.  https://doi.org/10.14423/SMJ.0000000000000166
  24. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med 2012;31:589-604.  https://doi.org/10.1016/j.csm.2012.07.001
  25. Horvath F, Kery L. Degenerative deformations of the acromioclavicular joint in the elderly. Arch Gerontol Geriatr 1984;3:259-65.  https://doi.org/10.1016/0167-4943(84)90027-X
  26. Precerutti M, Formica M, Bonardi M, Peroni C, Calciati F. Acromioclavicular osteoarthritis and shoulder pain: a review of the role of ultrasonography. J Ultrasound 2020;23:317-25.  https://doi.org/10.1007/s40477-020-00498-z
  27. Gialanella B, Prometti P. Effects of corticosteroids injection in rotator cuff tears. Pain Med 2011;12:1559-65.  https://doi.org/10.1111/j.1526-4637.2011.01238.x
  28. Desai VS, Camp CL, Boddapati V, Dines JS, Brockmeier SF, Werner BC. Increasing numbers of shoulder corticosteroid injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery. Arthroscopy 2019;35:45-50. https://doi.org/10.1016/j.arthro.2018.07.043