Management of glenohumeral osteoarthritis in the younger patient: A population level analysis of usual care delivery in a large health system.

OBJECTIVE

To characterize healthcare utilization in a younger population with glenohumeral osteoarthritis.

METHODS

Adults seeking care for glenohumeral osteoarthritis between July 2013 and March 2019 were analyzed. Ambulatory visits, pharmacological, and non-pharmacological treatment, and surgical and radiological procedures, were compared by active-duty status and sex. The association between exercise therapy receipt and subsequent surgery was modeled using an adjusted logistic regression, reporting adjusted odds ratios (OR).

RESULTS

There were 21,369 individuals (29.4 ​% female; mean age 50.3 [standard deviation (SD) 9.9] years), with 24.1 ​% military patients. The mean number of ambulatory shoulder visits per patient was 9.4 (SD 12.5). For pharmacological care 26.2 ​% received an injection, 14.8 ​% received non-steroidal anti-inflammatory drugs, 13.4 ​% opioids, 11.8 ​% muscle relaxants, and 9.9 ​% other analgesics. Non-pharmacological care included 44.5 ​% receiving exercise therapy, 41.6 ​% physiotherapy, and 32.6 ​% manual therapy, while 54.0 ​% received none of these. Radiographs were obtained for 51.3 ​% and advanced imaging for 47.1 ​%. Arthroscopic surgery occurred in 18.9 ​% and arthroplasty in 0.2 ​%. Military patients received less pharmacological and more non-pharmacological treatment that non-military patients. Males had 1.5x the odds of surgery and higher pharmacological treatment use than females. Receipt of exercise therapy (adjusted OR ​= ​0.01; 95 ​% confidence interval 0.01, 0.02) significantly reduced the odds of arthroscopic surgery.

CONCLUSION

Many patients received no interventions. For those receiving care, <50 ​% received guideline-recommended non-pharmacological care, including exercise therapy which significantly reduced the likelihood of surgery. Military patients had overall less pharmacological but more non-pharmacological treatment than non-military patients. A greater frequency of males had surgery. These findings indicate the need to further explore health care delivery for glenohumeral osteoarthritis in younger populations, highlighting potential guideline to practice gaps.