E2121. Glenohumeral Osteoarthritis: Imaging Modality Planning to Depict Staging and Grading Systems and What the Surgeon Needs From the Radiologist
Authors
Shyam Ramachandran;
University of Texas Southwestern
Flavio Duarte;
University of Texas Southwestern
Avneesh Chhabra;
University of Texas Southwestern
Background
Glenohumeral osteoarthritis (GHOA) is a widely prevalent disease with increasing frequency due to population aging. Different imaging grading and staging systems are used to decide upon patient management, and these are based of radiography, 3D CT, and MRI. The radiologists evaluating shoulder studies will benefit from the knowledge imparted by this work as to ‘how to’ assist the referring physicians and surgeons in proper planning and treatment of GHOA.
Educational Goals / Teaching Points
The goal of this educational exhibit is to provide radiologists with required and requisite imaging concepts and practically used grading and staging systems for optimal management of a patient with GHOA. Illustrative examples of different imaging modalities and severity scales of GHOA will be highlighted outlining the key imaging concepts pertinent for choosing among treatment options, such as conservative management, arthroscopy, and hemi-, conventional, or reverse shoulder arthroplasty.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Plain radiographs are used as the first imaging screening method to evaluate patients with shoulder complaints suggesting GHOA. Radiographic disease progression is evaluated using validated staging systems, such as Kellgren and Lawrence, Samson, and Hamada. For young patients with mild to moderate GHOA and failed conservative treatment, arthroscopic preservation surgery (APS) is usually considered. Older patients and those with severe GHOA benefit from different types of arthroplasties. Preoperative magnetic resonance imaging (MRI) is essential for APS surgical planning, as it maps repairable labral, cartilage, and rotator-cuff lesions. For arthroplasty planning, the status of glenoid cartilage and intactness of the rotator-cuff as well as glenoid morphology represent key factors guiding the decision regarding the most suitable hardware design and resurfacing, partial, total, or reverse joint replacement. Presurgical MRI or CT arthrogram is employed to evaluate the cartilage and rotator cuff tendon integrity and muscle atrophy. Finally, three-dimensional computed tomography (3D CT) is indicated to optimally assess the glenoid morphology (to determine Walch and Favard classifications, glenoid version, and bone loss) and analyze the necessity for glenoid osteotomy or graft ugmentation to correct the glenoid structural abnormalities for future success and longevity of the shoulder implants or chosen constructs.
Conclusion
The readers will learn optimal imaging modality indications and gain knowledge of different staging and grading systems used for outlining optimal management of GHOA. Learning the practical systems and measurement parameters which surgeons routinely use for planning treatments on such patients is essential to add value to the multidisciplinary care of GHOA patients and for delivering optimal patient care.
