Classification of primary glenohumeral osteoarthritis in a Turkish population - morphological study

Abstract

Aim: This study aimed to investigate the distribution of modified Walch classification groups in a Turkish patient population. We think that there may be glenoid morphologies that do not fit the modified Walch classification due to ethnic differences. Methods: Computed tomography images of 113 patients with primary glenohumeral osteoarthritis (GHOA) were evaluated. Version angle was measured according to the Friedman method, and classification was made by two blinded surgeons according to the modified Walch classification. Patients who did not meet the modified Walch groups were labeled as “Unclassifiable” and were analyzed as the 8th group. Results: The mean age of the patients was 85.5 ± 7.5 years. Forty-eight patients were male (42.5%). Eighty-two patients (72.6%) belonged to Walch group A (60 A1 and 22 A2, respectively). The total percentage of group B was 16.7% (20 patients). Two patients were included in the “Unclassifiable” group. One of the patients had glenoid convexity due to advanced disease with 1° anteversion. The other patient in this group had anterior subluxation without underlying pathology. Conclusion: The distribution of modified Walch groups in the Turkish population may be different from other populations. Posterior defective glenoid and excessive retroversion may concern less in the Turkish population with primary GHOA. Our results were obtained limited population and we think that further epidemiologic studies with larger sample size are needed.

Keywords

• glenohumeral joint
• osteoarthritis
• morphology
• Walch classification

Türk popülasyonunda primer glenohumeral osteoartrit sınıflaması – morfolojik çalışma

Öz

Amaç: Bu çalışmanın amacı, Türk popülasyonunda modifiye Walch sınıflamasına göre glenohumeral osteoartrit dağılımını belirlemektir. Etnik farklılıklar nedeniyle modifiye Walch sınıflamasına uymayan glenoid morfolojilerinin olabileceğini düşünmekteyiz. Yöntemler: Primer glenohumeral osteoartrit (GHOA) tanısı almış olan 113 hastanın bilgisayarlı tomografi görüntüleri incelendi. Versiyon açıları Friedman metoduna göre ölçüldü, ve iki cerrah tarafından modifiye Walch sınıflamasına göre sınıflandırma yapıldı. Modifiye Walch sınıflamasındaki kriterlere uymayan hastalar “tanımlanmamış tip” olarak adlandırıldı ve 8. grup olarak belirlendi. Bulgular: Hastaların ortalama yaşı 85.5 (±7.5) ve 48’ i erkek (%42,5) idi. 82 hasta (%72,6) Walch grup A (60 A1 ve 22 A2)’ya dahil idi. Grup B’ de 20 (%16,7) hasta var idi. 2 hasta tanımlanmamış grupta değerlendirildi. Bunlardan birinde 1 derecelik bir anteversiyonla ileri bir osteoartrit ve glenoid konveksitesi mevcut idi. Diğer hastada ise alta yatan başka bir patoloji olmaksızın anterior subluksasyon saptandı. Sonuç: Türk popülasyonundaki modifiye Walch gruplarının dağılımı diğer toplumlardan farklı olabilir. Primer GHOA olan hastalarda posterior defektif glenoid ve aşırı retroversiyonun daha az görüldüğü saptandı. Çalışmamız kısıtlı popülasyonda yapılmış olup daha geniş hasta grubunda daha net sonuçlar elde edilebileceğini düşünmekteyiz.

Anahtar Kelimeler

• Glenohumeral eklem
• osteoartrit
• morfoloji
• Walch sınıflaması

Kaynakça

1. Menge TJ, Boykin RE, Byram IR, Bushnell BD. A comprehensive approach to glenohumeral arthritis. South Med J. 2014;107:567-73.
2. Ho JC, Sabesan VJ, Iannotti JP. Glenoid component retroversion is associated with osteolysis. J Bone Joint Surg Am. 2013;95:e82.
3. Cabezas AF, Krebes K, Hussey MM, Santoni BG, Kim HS, Frankle MA, et al. Morphologic variability of the shoulder between the populations of North American and East Asian. Clin Orthop Surg. 2016;8:280-7.
4. Zhang Q, Shi LL, Ravella KC, Koh JL, Wang S, Liu C, et al. Distinct proximal humeral geometry in Chinese population and clinical relevance. J Bone Joint Surg Am. 2016;98:2071-81.
5. Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999;14:756-60.
6. Lowe JT, Testa EJ, Li X, Miller S, DeAngelis JP, Jawa A. Magnetic resonance imaging is comparable to computed tomography for determination of glenoid version but does not accurately distinguish between Walch B2 and C classifications. J Shoulder Elbow Surg. 2017;26:669-73.
7. Nowak DD, Gardner TR, Bigliani LU, Levine WN, Ahmad CS. Interobserver and intraobserver reliability of the Walch classification in primary glenohumeral arthritis. J Shoulder Elbow Surg. 2010;19:180-3.
8. Scalise JJ, Codsi MJ, Brems JJ, Iannotti JP. Inter-rater reliability of an arthritic glenoid morphology classification system. J Shoulder Elbow Surg. 2008;17:575-7.

9. Bercik MJ, Kruse K 2nd, Yalizis M, Gauci MO, Chaoui J, Walch G. A modification to the Walch classification of the glenoid in primary glenohumeral osteoarthritis using three-dimensional imaging. J Shoulder Elbow Surg. 2016;25:1601-6.
10. Shukla DR, McLaughlin RJ, Lee J, Cofield RH, Sperling JW, Sanchez-Sotelo J. Intraobserver and interobserver reliability of the modified Walch classification using radiographs and computed tomography. J Shoulder Elbow Surg. 2019;28:625-30.
11. Kidder JF, Rouleau DM, Pons-Villanueva J, Dynamidis S, DeFranco MJ, Walch G. Humeral head posterior subluxation on CT scan: Validation and comparison of 2 methods of measurement. Tech Shoulder Surg. 2010;11:72-76.
12. Jacxsens M, Karns MR, Henninger HB, Drew AJ, Van Tongel A, De Wilde L. Guidelines for humeral subluxation cutoff values: A comparative study between conventional, reoriented, and three-dimensional computed tomography scans of healthy shoulders. J Shoulder Elbow Surg. 2018;27:36-43.
13. Friedman RJ, Hawthorne KB, Genez BM. The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg Am. 1992;74:1032-7.
14. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159-74.
15. Neyton L, Gauci MO, Deransart P, Collette P, Walch G, Athwal GS. Three-dimensional characterization of the anteverted glenoid (type D) in primary glenohumeral osteoarthritis. J Shoulder Elbow Surg. 2019;28:1175-82.
16. Walker KE, Simcock XC, Jun BJ, Iannotti JP, Ricchetti ET. Progression of Glenoid Morphology in Glenohumeral Osteoarthritis. J Bone Joint Surg Am. 2018;100:49-56.
17. Rouleau DM, Kidder JF, Pons-Villanueva J, Dynamidis S, Defranco M, Walch G. Glenoid version: how to measure it? Validity of different methods in two-dimensional computed tomography scans. J Shoulder Elbow Surg. 2010;19:1230-7.