J. Sharan (Glenview, US)
The Foundation for Orthopaedics and Regenerative MedicinePresenter Of 3 Presentations
P145 - The Grashey True Shoulder AP X-Ray Accurately Reflects Glenohumeral Joint Space and Predicts PRP Efficacy, The Traditional AP Does Neither
Abstract
Purpose
To demonstrate that the shoulder AP view radiograph does not accurately reflect true glenohumeral (GH) joint space narrowing when compared to the Grashey view.
Methods and Materials
A total of 111 patients (122 shoulders) who received evaluation for various shoulder pathologies were included in the study. All patients received baseline Grashey and AP view radiographs. A comparative analysis based on joint space was performed to compare both radiographs of the shoulder. A subgroup of 45 shoulders receiving PRP injection for the treatment of glenohumeral osteoarthritis (GHOA) had previously shown significant efficacy on survivorship, global improvement, SANE and DASH evaluation.
Results
The mean Grashey joint space was 2.8 mm compared to 5.3 mm for the AP joint space. The mean joint space difference between the two views was 2.5 mm (P < 0.0001). Evaluation of the joint space, as measured by AP radiographs, resulted in a 57.4% false negative rate for glenohumeral osteoarthritis. A total of 8 patients received a joint replacement at two year follow up. Of these patients, 7 were in the 0-1 mm Grashey joint space group while only 4 were in the 0-1 mm AP joint space group. There was a 25.3% (p=0.04) difference in the number of responders (≥ 30% Global Improvement) between the 0-1 and 2+ Grashey groups at 6 months follow up. The difference in the number of responders when comparing the AP groups was not statistically significant.
Conclusion
The AP radiograph of the shoulder does not accurately measure, and tends to overestimate, the GH joint space, resulting in a significant amount of false negative GHOA diagnoses. The Grashey view radiograph correlated with clinical outcomes further validating the importance of obtaining an accurate GH joint space, i.e. Grashey radiograph.
P211 - PRP Injection of the Arthritic Glenohumeral Joint is Safe, Effective, and Avoids Joint Replacement in Many Patients at 2-8 year Follow-Up.
Abstract
Purpose
Platelet Rich Plasma (PRP) injection has been shown to benefit knee osteoarthritis (OA). We are unaware of any published studies evaluating efficacy for glenohumeral shoulder OA. We hypothesized that PRP would be safe, would improve glenohumeral OA, and would result in joint replacement avoidance in many patients.
Methods and Materials
A total of 45 shoulders with clinical and radiographic OA were included in the study. Patients received a single injection of PRP into the glenohumeral joint from a posterior approach under ultrasound guidance. Shoulders were divided into group 1 which had 0-1 mm of joint space on the Grashey (true AP) view of the shoulder and group 2 which had at least 2mm of joint space on the Grashey view. Outcomes included safety, survivorship/joint replacement avoidance, DASH, SANE, and global improvement percentage. Follow up was performed at 6 months, 1 year, and at least 2 years post treatment.
Results
No serious adverse events occurred as a result of the treatment. Joint replacement avoidance percentage was 92.6, 84, and 72 for group 1 and 100, 100, and 93.3 for group 2 at 6, 12, and 24 months, respectively. Global Improvement percentage was 31.3, 26.3, and 27.4 for group 1 and 57.2, 37.4, and 47.3 for group 2 at 6, 12, and 24 months, respectively. The global improvement difference between group 1 and 2 was statistically significant at 6 months. Sane scores were improved at 6 months with greater improvement at 1 year which was sustained at two to eight year follow up. Short DASH scores improved by 6.5 points at two year follow up.
Conclusion
PRP injection of the arthritic glenohumeral joint is safe, effective for most patients, and results in a high rate of survivorship/joint replacement avoidance even in bone on bone shoulders at two to eight year follow up.
P219 - PRP Injection Resulted in Joint Replacement Avoidance in 568 OA Knees at 3 - 7 Year Follow Up, Even Bone on Bone
Abstract
Purpose
Most knee PRP studies report only short term results and fail to assess total knee replacement (TKR) avoidance/joint survivorship as an outcome. We wished to evaluate the efficacy of PRP at 3 year follow up with particular attention to TKR avoidance.
Methods and Materials
This prospective study examines the outcomes of patients with medial and lateral KOA who were treated with PRP and followed for 3 to 7 years. 568 knees (487 patients) with KOA were treated with PRP injections. All patients had medial or lateral KOA diagnosed by physical exam and confirmed by x-ray. Outcomes included joint survivorship, global improvement, safety, Single Assessment Numeric Evaluation (SANE) scores and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Evaluations were performed 6 months, 1 year, 18 months, 2 years, and 3 years after treatment.
Results
207 males and 280 females with a mean age of 65 years were treated. 456 patients had medial KOA and 112 had lateral KOA. No serious adverse events were seen. Patients were separated into 6 groups based on joint space measured on standing AP x-ray (0-1mm, 2-4mm and 5+mm) and site of KOA (medial or lateral). 101 knees received total knee arthroplasty (TKA) by 36 months, for a total survivorship of 75% at 3 years. Survivorship was 64% for the 0-1mm group, 77% for the 2-4mm group and 91% for the 5+mm group at 3 years. There were significant improvements in both SANE scores and WOMAC scores by 6 month follow up and these improvements were maintained throughout the three year follow up. Linear regression analysis demonstrated no significant change in efficacy when factoring in BMI and age.
Conclusion
PRP for the treatment of medial and/or lateral KOA has excellent survivorship out to 3 years even in bone on bone, elderly, and obese patients.
Presenter Of 3 Presentations
P145 - The Grashey True Shoulder AP X-Ray Accurately Reflects Glenohumeral Joint Space and Predicts PRP Efficacy, The Traditional AP Does Neither
Abstract
Purpose
To demonstrate that the shoulder AP view radiograph does not accurately reflect true glenohumeral (GH) joint space narrowing when compared to the Grashey view.
Methods and Materials
A total of 111 patients (122 shoulders) who received evaluation for various shoulder pathologies were included in the study. All patients received baseline Grashey and AP view radiographs. A comparative analysis based on joint space was performed to compare both radiographs of the shoulder. A subgroup of 45 shoulders receiving PRP injection for the treatment of glenohumeral osteoarthritis (GHOA) had previously shown significant efficacy on survivorship, global improvement, SANE and DASH evaluation.
Results
The mean Grashey joint space was 2.8 mm compared to 5.3 mm for the AP joint space. The mean joint space difference between the two views was 2.5 mm (P < 0.0001). Evaluation of the joint space, as measured by AP radiographs, resulted in a 57.4% false negative rate for glenohumeral osteoarthritis. A total of 8 patients received a joint replacement at two year follow up. Of these patients, 7 were in the 0-1 mm Grashey joint space group while only 4 were in the 0-1 mm AP joint space group. There was a 25.3% (p=0.04) difference in the number of responders (≥ 30% Global Improvement) between the 0-1 and 2+ Grashey groups at 6 months follow up. The difference in the number of responders when comparing the AP groups was not statistically significant.
Conclusion
The AP radiograph of the shoulder does not accurately measure, and tends to overestimate, the GH joint space, resulting in a significant amount of false negative GHOA diagnoses. The Grashey view radiograph correlated with clinical outcomes further validating the importance of obtaining an accurate GH joint space, i.e. Grashey radiograph.
P211 - PRP Injection of the Arthritic Glenohumeral Joint is Safe, Effective, and Avoids Joint Replacement in Many Patients at 2-8 year Follow-Up.
Abstract
Purpose
Platelet Rich Plasma (PRP) injection has been shown to benefit knee osteoarthritis (OA). We are unaware of any published studies evaluating efficacy for glenohumeral shoulder OA. We hypothesized that PRP would be safe, would improve glenohumeral OA, and would result in joint replacement avoidance in many patients.
Methods and Materials
A total of 45 shoulders with clinical and radiographic OA were included in the study. Patients received a single injection of PRP into the glenohumeral joint from a posterior approach under ultrasound guidance. Shoulders were divided into group 1 which had 0-1 mm of joint space on the Grashey (true AP) view of the shoulder and group 2 which had at least 2mm of joint space on the Grashey view. Outcomes included safety, survivorship/joint replacement avoidance, DASH, SANE, and global improvement percentage. Follow up was performed at 6 months, 1 year, and at least 2 years post treatment.
Results
No serious adverse events occurred as a result of the treatment. Joint replacement avoidance percentage was 92.6, 84, and 72 for group 1 and 100, 100, and 93.3 for group 2 at 6, 12, and 24 months, respectively. Global Improvement percentage was 31.3, 26.3, and 27.4 for group 1 and 57.2, 37.4, and 47.3 for group 2 at 6, 12, and 24 months, respectively. The global improvement difference between group 1 and 2 was statistically significant at 6 months. Sane scores were improved at 6 months with greater improvement at 1 year which was sustained at two to eight year follow up. Short DASH scores improved by 6.5 points at two year follow up.
Conclusion
PRP injection of the arthritic glenohumeral joint is safe, effective for most patients, and results in a high rate of survivorship/joint replacement avoidance even in bone on bone shoulders at two to eight year follow up.
P219 - PRP Injection Resulted in Joint Replacement Avoidance in 568 OA Knees at 3 - 7 Year Follow Up, Even Bone on Bone
Abstract
Purpose
Most knee PRP studies report only short term results and fail to assess total knee replacement (TKR) avoidance/joint survivorship as an outcome. We wished to evaluate the efficacy of PRP at 3 year follow up with particular attention to TKR avoidance.
Methods and Materials
This prospective study examines the outcomes of patients with medial and lateral KOA who were treated with PRP and followed for 3 to 7 years. 568 knees (487 patients) with KOA were treated with PRP injections. All patients had medial or lateral KOA diagnosed by physical exam and confirmed by x-ray. Outcomes included joint survivorship, global improvement, safety, Single Assessment Numeric Evaluation (SANE) scores and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Evaluations were performed 6 months, 1 year, 18 months, 2 years, and 3 years after treatment.
Results
207 males and 280 females with a mean age of 65 years were treated. 456 patients had medial KOA and 112 had lateral KOA. No serious adverse events were seen. Patients were separated into 6 groups based on joint space measured on standing AP x-ray (0-1mm, 2-4mm and 5+mm) and site of KOA (medial or lateral). 101 knees received total knee arthroplasty (TKA) by 36 months, for a total survivorship of 75% at 3 years. Survivorship was 64% for the 0-1mm group, 77% for the 2-4mm group and 91% for the 5+mm group at 3 years. There were significant improvements in both SANE scores and WOMAC scores by 6 month follow up and these improvements were maintained throughout the three year follow up. Linear regression analysis demonstrated no significant change in efficacy when factoring in BMI and age.
Conclusion
PRP for the treatment of medial and/or lateral KOA has excellent survivorship out to 3 years even in bone on bone, elderly, and obese patients.