Treatment of Elbow Osteoarthritis with Arthroscopic Debridement and Intra-Articular HA Injection

Abstract

This study investigates efficacy of arthroscopic debridement with or without intra-articular hyaluronic acid (HA) injections for pain relief, ROM, and functional improvement in 30 elbows with osteoarthritis - primary degenerative or post-traumatic. 30 elbows were treated for posttraumatic (n=12) or primary degenerative (n=18) elbow osteoarthritis by arthroscopic debridement. HA injection protocol was either preoperative (6 cases), postoperative (n=4), combined pre/post-operative (n=5) intraarticular HA (Synvisc) injections, or without additional Synvisc injections (n=9). A clinical examination and Mayo elbow performance score was conducted at an average of 15 months (range 12-18) post-operation. The results were analyzed with the Mann-Whitney and Wilcoxon tests. Intra-articular cartilage changes were observed to be mild fraying (n=7), significant fraying / fibrilliation (n=9), and significant fibrillation with areas of bare bone (n=14). The treatment resulted in statistically significant pain reduction for both posttraumatic and primary degenerative OA groups. Pain relief was significantly better in the group with exposed bony areas following debridement alone, compared to the group without visible bone, (p = 0.005). In patients with exposed bone, pain relief was significantly better without additional intra-articular HA (p = 0.039). MEPS improved by 30 points (p < 0.0001 Wilcoxon test), with p = 0.008 in the posttraumatic group and p = 0.0005 in the primary degenerative group. There was greater improvement in the group with exposed bone without additional HA, and improved trend in the group with mild cartilage fraying with additional HA. Our findings reveal a trend toward symptomatic and functional benefit when HA is combined with debridement in osteoarthritic elbow joints without exposed bone. There is a symptomatic detriment associated with HA in osteoarthritic joints with exposed bony areas. Our results support the use of HA in combination with elbow debridement in earlier stages of osteoarthritis, but not in advanced cases with exposed bone.