Elbow Arthroscopy Complications in Pediatrics and Adults

Abstract

Objectives:The risks of elbow arthroscopy, have been previously described by Kelly et al (2001) with 473 consecutive elbow arthroscopies from 1980-1998. Since that time, the field of elbow arthroscopy has drastically changed and the complexity of procedures increased. Another report by Nelson et al in 2014, shared the results of 417 consecutive elbow arthroscopy performed over a thirteen year period by three orthopedic surgeons who have completed specialized subspecialty training in shoulder and elbow surgery. While this data set highlights the complication rate of three highly trained surgeons, it may fail to capture the true rate of complications observed with elbow arthroscopy in a community practice. We reviewed the complications of elbow arthroscopy in a community practice with multiple surgeons. In addition, we analyzed the difference in complication rate between adult and pediatric patients.Methods:After institutional IRB approval, the database of an integrated healthcare including 13 medical centers with a captured population was reviewed for all elbow arthroscopies that occurred in the eight year period between 2006 and 2014. A chart review was performed on over 349 consecutive elbow arthroscopies in 322 patients performed by 28 board certified orthopedic surgeons. The average length of follow up was 361 days (0-2739 days). Major complications included deep infection, compartment syndrome, vascular injury, re-hospitalization, deep vein thrombosis, and pulmonary embolus. Minor complications include superficial infection, heterotopic ossification and transient nerve palsies.Results:Of the 349 procedures, the most common complications include heterotopic ossification (eleven patients), transient nerve palsies (twenty six patients), and loss of range of motion (sixty six patients). Loss of range of motion was defined as greater than 10 degrees loss of flexion/extension arc from preoperative visit to final followup. There were twenty six transient nerve palsies (fourteen ulnar, six radial, three median, three medial antebrachial cutaneous). There was one deep infection and eight superficial infections. Forty six patients required reoperation. No patients had vascular injury, compartment syndrome, deep vein thrombosis, or pulmonary embolism. One patient required re-hospitalization for a deep infection post operatively.Conclusion:Elbow arthroscopy remains a safe procedure with a 7.4% risk of nerve palsy, with the ulnar nerve being the most frequently nerve injured. These results are comparable to previously published studies.Table 1:Patient DemographicsAdultPediatricNumber of Patients219107Average age (years)42.5 (19-83)15.2 (5-18)Number of Surgeons2821Number of arthroscopies233114Number of elbows224107Average length of follow up (days)327.5 (0-2652)431 (6-2739)Table 2:Complications of Elbow ArthroscopyAdultPediatricMedial antebrachial cutaneous nerve palsy3 (1.3%)0 (0%)Ulnar nerve palsy12 (5.2%)2 (1.8%)Median nerve palsy3 (1.3%)0 (0%)Radial nerve palsy5 (2.1%)1 (0.9%)Superficial infection7 (3.0%)1 (0.9%)Deep infection1 (0.4%)0 (0%)Heterotopic Ossification9 (3.9%)2 (1.8%)Loss of motion46 (19.7%)20 (17.5%)Re-operation28 (12.0%)18 (15.8%)Re-hospitalization1 (0.4%)0 (0%)Deep Vein Thrombosis0 (0%)0 (0%)Pulmonary Embollism0 (0%)0 (0%)Vascular injury0 (0%)0 (0%)Compartment syndrome0 (0%)0 (0%)Table 3:Surgical IndicationsAdultPediatricContracture12224Loose body10541Degenerative arthritis893Rheumatoid arthritis150Lateral epicondylitis141Valgus extension overload1321Medial epicondylitis62Osteochondral defect450Septic arthritis20