Radiologic severe osteoarthritis is related to worse clinical outcomes after arthroscopic osteocapsular arthroplasty in primary elbow osteoarthritis for a medium-term follow-up: A retrospective cohort study.

Abstract

This study aimed to compare the clinical outcomes after arthroscopic OCA in the medium-term follow-up according to the radiologic severity of primary elbow OA and assess serial changes in clinical outcomes in each group. Patients treated using arthroscopic OCA for primary elbow OA with a minimum 3 years of follow-up, from January 2010 to April 2019, were retrospectively assessed for range of motion (ROM), visual analog scale (VAS) pain score, and Mayo Elbow Performance Score (MEPS), preoperatively and at short- (postoperative 3 to 12 months) and medium-term (at least 3 years after surgery) follow-ups postoperatively. Preoperative computed tomography was performed to evaluate the radiologic severity of OA using the Kwak's classification. Clinical outcomes were compared according to the radiologic severity of OA by their absolute values and the number of patients achieving patient acceptable symptomatic state (PASS). Serial changes in the clinical outcomes of each subgroup were also assessed. Of the 43 patients, 14, 18, and 11 were classified as stage I, II, and III groups, respectively; the mean follow-up duration was 71.3 ± 28.9 months and mean age was 56.5 ± 7.2 years. At the medium-term follow-up, stage I group had better ROM arc (I, 114°±14°; II, 100°±23°; and III, 97°±20°; P =.067) and VAS pain score (I, 0.9±1.3; II, 1.8±2.1; and III, 2.4±2.1; P =.168) than stage II and III groups without reaching statistical significance, while stage I group had significantly better MEPS (I, 93.2±7.5; II, 84.7±11.9; III, 78.6±15.2; P = .017) than stage III group. The percentage achieving PASS for ROM arc (P =.684) and VAS pain score (P =.398) were comparable between three groups, however, the percentage achieving PASS for MEPS was significantly higher in the stage I group than stage III group (I vs III, 100.0% vs 54.5%; P =.016). During serial assessment, all clinical outcomes tended to improve at the short-term follow-up. Compared to the short-term period, the ROM arc tended to decrease at the medium-term follow-up while VAS pain score and MEPS overall did not show significant changes. After arthroscopic OCA, stage I showed overall better ROM arc and pain than stage II and III at the medium-term follow-up, while stage I showed significantly better MEPS and higher percentage of patients achieving PASS for MEPS than stage III.