Summary

The purpose of this study was to identify predictive factors for the time from initial presentation to primary TSA in patients with glenohumeral OA or rotator cuff (RTC) arthropathy managed conservatively with corticosteroid injections.

Abstract

Purpose

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 2010-2021. 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 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 and 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 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).

Conclusion

The time course from initial presentation to TSA is similar between primary OA and RTC arthropathy patients managed conservatively with corticosteroid injections, but there are distinct prognostic factors for progression to TSA in both groups. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

Level of Evidence
III