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Glenohumeral osteoarthritis: what the surgeon needs from the radiologist

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Abstract

Glenohumeral osteoarthritis (GHOA) is a widely prevalent disease with increasing frequency due to population aging. Both clinical manifestations and radiography play key roles in the initial diagnosis, staging, and management decisions. Radiographic disease progression evaluation is performed using validated staging systems, such as Kellgren and Lawrence, Samilson, 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 rotator cuff as well as glenoid morphology represent key factors guiding the decision regarding the most suitable hardware design, whether resurfacing, partial, total, or reverse joint replacement. Pre-surgical MRI or alternatively computed tomography arthrogram is employed to evaluate the cartilage and rotator cuff. Finally, three-dimensional computed tomography (3D CT) is indicated to optimally assess the glenoid morphology (to determine Walch classification, version, inclination, and bone loss) and analyze the necessity for glenoid osteotomy or graft augmentation to correct the glenoid structural abnormalities for future success and longevity of the shoulder implants or chosen constructs. Understanding the purpose of each imaging and treatment modality allows more efficient image interpretation. This article reviews the above concepts and details what a surgeon needs from a radiologist and could benefit from accurate reporting of preoperative imaging studies.

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Authors and Affiliations

  1. Musculoskeletal Radiology, UT Southwestern, Dallas, TX, 75390-9178, USA

    Flavio Duarte Silva, Shyam Ramachandran & Avneesh Chhabra

  2. Orthopedic Surgery, UT Southwestern, Dallas, TX, 75390-9178, USA

    Avneesh Chhabra

  3. Johns Hopkins University, Baltimore, MD, USA

    Avneesh Chhabra

  4. University of Dallas, Irving, TX, USA

    Avneesh Chhabra

  5. Walton Centre for Neuroscience, Liverpool, UK

    Avneesh Chhabra

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  1. Flavio Duarte Silva
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Correspondence to Avneesh Chhabra.

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AC: consultant: ICON Medical and TREACE Medical Concepts Inc.; Book Royalties: Jaypee, Wolters; speaker: Siemens; medical advisor: Image biopsy Lab Inc.; research grant: Image biopsy Lab Inc. The authors declare no competing interests.

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Key points

1. Radiography remains the initial screening imaging modality to grade GHOA, differentiate primary from secondary joint degeneration, and decide for surgical indication.

2. Cross-sectional imaging aids in deciding between arthroscopic preservation surgery versus arthroplasty.

3. 3D CT-generated glenoid version, inclination, and bone stock measurements assist in preoperative planning for arthroplasty.

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Silva, F.D., Ramachandran, S. & Chhabra, A. Glenohumeral osteoarthritis: what the surgeon needs from the radiologist. Skeletal Radiol 52, 2283–2296 (2023). https://doi.org/10.1007/s00256-022-04206-2

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