Primary Osteoarthritis Of Elbow Research Articles

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.

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.

Clinical Outcomes of Revision Arthroscopic Osteocapsular Arthroplasty in Primary Elbow Osteoarthritis: A Retrospective Cohort Study

Background: Arthroscopic osteocapsular arthroplasty (OCA) achieves significant medium-term outcomes in patients with primary elbow osteoarthritis (OA); however, outcomes after revision arthroscopic OCA are not well known. Purpose: To assess clinical outcomes after revision arthroscopic OCA as compared with those after primary surgery in patients with OA. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic OCA attributed to primary elbow OA between January 2010 and July 2020 were enrolled. Range of motion (ROM), visual analog scale (VAS) pain score, and Mayo Elbow Performance Score (MEPS) were assessed. Operation time and complications were assessed by chart review. Clinical outcomes between the primary and revision surgery groups were compared, and subgroup analysis for radiologically severe OA was performed. Results: Data from 61 patients were analyzed (primary, n = 53; revision, n = 8). The mean ± SD age was 56.3 ± 8.5 and 54.3 ± 8.9 years in the primary and revision groups, respectively. The primary group had significantly better ROM arcs preoperatively (89.9°± 20.3° vs 71.3°± 22.3°; P = .021) and postoperatively (112.4°± 17.1° vs 96.9°± 16.5°; P = .019) than the revision group; however, the degree of improvement was comparable (P = .445). Postoperative VAS pain score (P = .164) and MEPS (P = .581) were comparable between the groups, as were the degrees of improvement in VAS pain score (P = .691) and MEPS (P = .604). The revision group required a significantly longer operative time than the primary group (P = .004) and had a nonsignificant higher complication rate (P = .065). Subgroup analysis showed that radiologically severe cases in the primary group had significantly better preoperative (P = .010) and postoperative (P = .030) ROM arcs than the revision group and a comparable postoperative VAS pain score (P = .155) and MEPS (P = .658). Conclusion: Revision arthroscopic OCA is a favorable treatment option for primary elbow OA with recurrent symptoms. Postoperative ROM arc was worse after revision surgery as compared with primary surgery; however, the degree of improvement was comparable. Postoperative VAS pain score and MEPS were comparable with primary surgery.

Serial Changes in Clinical Outcomes After Arthroscopic Osteocapsular Arthroplasty for Primary Elbow Osteoarthritis: A Medium-term Follow-up Study.

Arthroscopic osteocapsular arthroplasty (OCA) shows promising short-term outcomes for primary elbow osteoarthritis (OA). However, serial changes in clinical outcomes for medium-term follow-up are not well known. To evaluate clinical outcomes after arthroscopic OCA in primary elbow OA from preoperative to short- and medium-term follow-up and to analyze the correlation between the time from short- to medium-term follow-up and the changes in clinical outcomes between the periods. Case series; Level of evidence, 4. Patients with primary elbow OA who were treated with arthroscopic OCA between January 2010 and April 2020 were evaluated. Elbow range of motion (ROM), visual analog scale (VAS) for pain, and Mayo Elbow Performance Score (MEPS) were assessed preoperatively and at short-term (3-12 months) and medium-term (≥2 years) follow-up. The correlation between the time from short- to medium-term follow-up and the changes in clinical outcomes was analyzed using the Pearson correlation coefficient. Included were 56 patients who underwent short-term follow-up (mean [range], 5.9 [3-12] months) and medium-term follow-up (62.2 [24-129] months) after arthroscopic OCA. When compared with preoperative values, significant improvements were seen at short-term follow-up: ROM (from 89.4° to 111.7°; P < .001), VAS for pain (from 4.9 to 2.0; P < .001), and MEPS (from 62.3 to 83.7; P < .001). From short- to medium-term follow-up, ROM decreased (from 111.7° to 105.4°; P = .001) while VAS for pain (from 2.0 to 1.4; P = .031) and MEPS (from 83.7 to 87.8; P = .016) improved. All outcomes improved significantly at medium-term follow-up as compared with preoperative values (P < .001 for all). The time between short- and medium-term follow-up had a significant positive correlation with decreased ROM (r = 0.290; P = .030) and a significant negative correlation with improvement in MEPS (r = -0.274; P = .041). Serial assessment of patients with primary elbow OA who underwent arthroscopic OCA showed that the clinical outcomes improved from preoperative assessment to short- and medium-term follow-up, although ROM decreased between short- and medium-term follow-up. VAS for pain and MEPS showed continued improvement until medium-term follow-up.

ELBOW OSTEOARTHRITIS: PATHOGENESIS, CLINICAL PRESENTATION, WORK-UP

ABSTRACT Degenerative joint disease of the elbow, although much rarer than in lower limbs, affecting about 2% of population, may be the result of primary and secondary etiologies and may significantly affect the quality of life, leading to pain, loss of motion and functional disability. A detailed medical history combined with physical examination and imaging modalities can help to locate the source of symptoms and choose the appropriate treatment. Nonoperative management is the initial therapy for elbow arthritis and is limited to relief of pain by rest, activity modification, analgesics and nonsteroid anti-inflammatory medications. When conservative management fails, surgical treatment should be used according to the patient’s expectations, age, severity and etiology of elbow arthritis. Patients with posttraumatic and primary elbow osteoarthritis in mild and moderate stage of disease may be treated by arthroscopic osteocapsular arthroplasty which consist of soft tissue and bony debridement, osteophytes and loose bodies removal, synovectomy, capsular release and bony contouring of humerus and ulnae. Total elbow arthroplasty is dedicated to low-demand, elderly patients with rheumatoid, inflammatory, posttraumatic or primary elbow osteoarthritis in severe stage. For younger, high-demand patients with severe osteoarthritis of the elbow which affects the majority of the ulnohumeral articular surface a good option for surgical treatment is interposition arthroplasty with/using auto or allografts.

Radiocapitellar Arthroplasty: Systematic Review.

Primary elbow osteoarthritis affects approximately 2% of the population, and has been treated with arthroplasty. However, total elbow arthroplasty (TEA) implants currently have severe weight limitations and issues with longevity. In patients with unicompartmental arthritis, unicompartmental arthroplasty may be used instead of TEA. We describe the use of Uni-Elbow Radio-Capitellum and Lateral Resurfacing Elbow for radiocapitellar arthroplasty (RCA) in this article. Reviewers independently searched databases for keywords, such as radiocapitellar arthroplasty, RCA, uni-elbow radiocapitellum, UNI-E, and lateral resurfacing elbow, LRE. The measured outcomes of interest were the change in motion arc and patient-reported outcome scores. Studies that were not of appropriate quality determined by the Cochrane risk of bias summary tool and review studies were excluded. RCA resulted in a postoperative 38.3° ± 28.5° increase in elbow flexion-extension (P < .001), and 35.2° ± 28.6° increase in elbow pronation-supination (P < .001). Mayo Elbow Performance Score was significantly increased by 44.8 ± 12.6. DASH Score saw a significant reduction by 45.0 ± 14.6 points (P < .001), while the American Shoulder and Elbow Surgeons Score increased by 47.0 ± 10.6 points (P < .001). Of the 105 adult patients 16.2% experienced complications such as minor stiffness, ulnar neuropathy, component loosening, or radial head UNI-E stem failure. Reported complications were higher in the UNI-E group than in the LRE group. RCA has shown promise as an option to treat radiocapitellar arthritis, particularly when excising the radial head causes lateral column instability.

Recovery from open osteocapsular débridement for primary elbow osteoarthritis is rapid and does not depend on preoperative motion.

Osteocapsular débridement is a surgical treatment for functionally limiting primary elbow osteoarthritis (PEOA). We hypothesized that postoperative improvement in range of motion (ROM) following elbow osteocapsular débridement could be grouped into predictable patterns. We also hypothesized that significant improvements in ROM frequently take place for up to 6 months after surgery. A retrospective chart review of patients who underwent open elbow débridement for PEOA was performed. Demographic information and surgical approach were recorded. ROM data were also collected at preoperative, intraoperative, and postoperative intervals of 2 weeks, 6 weeks, 3 months, and 6 months. Growth mixture modeling and latent class growth analysis were performed to identify groups of motion recovery trajectories, while Student's t-tests were performed to compare ROM data between intervals. Our study included 76 patients who underwent open elbow débridement (9 with a lateral approach, 55 medial, and 12 both) for PEOA. The mean preoperative arc of motion was 95°±22°. This improved to a mean final motion arc of 127°±11 at final follow-up, which was 92% of the mean intraoperative arc. The mean time to achieve final motion was 3 months, with 79% of patients achieving their final ROM arc by this point. Patients achieved an average of 85% of their final arc of motion by the 2-week postoperative visit (92% of final flexion and 61% of final extension). Growth mixture modeling and latent class growth analysis did not identify any statistically significant groupings for postoperative ROM progression trajectories. Arc of motion preoperatively, intraoperatively, and at 2 weeks postoperatively did not correlate with the final arc of motion. There were no characteristics or thresholds of motion which conferred a higher likelihood of achieving a better result postoperatively. ROM recovery after osteocapsular débridement for PEOA is not dependent on preoperative, intraoperative, or 2-week postoperative arcs of motion. Most of the ROM recovery occurs in the early postoperative period, with flexion restored preferentially faster than extension. The final arc of motion can be expected by 3 months postoperatively. This knowledge has potential benefit in affecting patients' personal time commitment to rehabilitation and the overall cost for therapy and splinting beyond the 3-month time point.

Long-term survivorship of open débridement and débridement arthroplasty for elbow arthritis: a retrospective chart review.

Open débridement and Outerbridge-Kashiwagi (OK) débridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis, but little is known about their long-term survivorship. The purpose of this study was to determine whether survivorship until conversion to total elbow replacement and revision surgery was better for the OK procedure compared with open débridement. We performed a retrospective chart review of patients who underwent open elbow surgical débridement (open débridement or OK procedure) between 2000 and 2015. Patients received a diagnosis of primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients underwent surgery including open débridement (n=142) or the OK procedure (n=178), and of these patients, 33 required secondary revision surgery (open débridement, n=14; OK procedure, n=19). The average time since surgery was 11.5 years (range, 5.5-21.5 years). Survivorship was analyzed with Kaplan-Meier curves and the log rank test. A Cox proportional hazards model was used to estimate the effect of the type of procedure, index diagnosis, age, and sex on survivorship. Kaplan-Meier survival curves showed survivorship rates until total elbow arthroplasty of 100.0% at 1 year, 99.3% at 5 years, and 98.5% at 10 years for open débridement and 100.0% at 1 year, 98.8% at 5 years, and 98.0% at 10 years for the OK procedure (P=.87). There was no difference in survivorship between procedures, even after adjustment for significant covariates. The rates of revision for open débridement and the OK procedure were similar, at 11.3% and 11.5%, respectively, after 10 years. Higher rates of revision surgery were observed in patients who underwent open débridement (hazard ratio, 4.84; 95% confidence interval, 1.29-18.17; P=.019) compared with those who underwent the OK procedure after adjustment for covariates. We performed a stratified analysis with radiographic severity as an effect modifier and showed that patients with grade 3 arthritis fared better after the OK procedure compared with open débridement in terms of survivorship until revision surgery (P=.05). However, such a difference was not found for grade 1 or grade 2 arthritis. We showed that both open elbow débridement and the OK procedure had excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post-traumatic cases that could help delay the need for total elbow arthroplasty. Patients with more severe radiographic arthritis, specifically grade 3 arthritis, were less likely to require revision surgery if treated initially with the OK procedure compared with open débridement.

Effectiveness analysis of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy

To explore the effectiveness of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy. The clinical data of 32 patients with primary elbow osteoarthritis combined with stiffness between June 2018 and December 2020 were retrospectively analyzed. There were 22 males and 10 females with an average age of 53.4 years (range, 31-71 years). X-ray film and three-dimensional CT examinations showed osteophytes of varying degrees in the elbow joint. Loose bodies existed in 16 cases, and there were 7 cases combined with ulnar nerve entrapment syndrome. The median symptom duration was 2.5 years (range, 3 months to 22.5 years). The location of bone impingement from 0° extension to 140° flexion of the elbow joint was simulated by computer-aided technology before operation and a three-dimensional printed model was used to visualize the amount and scope of impinging osteophytes removal from the anterior and posterior elbow joint to accurately guide the operation. Meanwhile, the effect of elbow joint release and impinging osteophytes removal was examined visually under arthroscopy. The visual analogue scale (VAS) score, Mayo elbow performance score (MEPS), and elbow range of motion (extension, flexion, extension and flexion) were compared between before and after operation to evaluate elbow function. The mean operation time was 108 minutes (range, 50-160 minutes). All 32 patients were followed up 9-18 months with an average of 12.5 months. There was no other complication such as infection, nervous system injury, joint cavity effusion, and heterotopic ossification, except 2 cases with postoperative joint contracture at 3 weeks after operation due to the failure to persist in regular functional exercises. Loose bodies of elbow and impinging osteophytes were removed completely for all patients, and functional recovery was satisfactory. At last follow-up, VAS score, MEPS score, extension, flexion, flexion and extension range of motion significantly improved when compared with preoperative ones ( P<0.05). Arthroscopic treatment of primary elbow osteoarthritis combined with stiffness using computer-aided technology can significantly reduce pain, achieve satisfactory functional recovery and reliable effectiveness.

Progression patterns of range of motion progression after open release for post-traumatic elbow stiffness.

Background & HypothesisPost-traumatic stiffness of the elbow may be treated surgically with open osteocapsular release. This study investigated postoperative range of motion (ROM) improvements after this procedure. We hypothesized that there would be predictable recovery patterns and significant progress up to 6 months after surgery.MethodsA retrospective chart review of patients who underwent open elbow release for post-traumatic stiffness (PTS) was performed. Demographic information and surgical approach were recorded. Patients with ipsilateral primary elbow osteoarthritis were excluded. Range of motion (ROM) data were collected at preoperative, intraoperative, and postoperative intervals of 2 weeks, 6 weeks, 3 months, and 6 months. Growth mixture modeling (GMM) and latent class growth analysis (LCGA) were performed to identify motion recovery trajectory groups, and Student's t-tests were performed to compare ROM data between intervals.ResultsOne hundred and eighty-seven patients who underwent open elbow release for PTS were included (112 with a medial approach, 50 lateral, and 25 both). The mean preoperative arc was 84° ± 31, and the arc of motion at final follow-up was 119° ± 19 (P < .05). The mean time to the final follow-up arc of motion was 16 weeks, with 56% of patients achieving their final arc by their 3-month follow-up visit. The largest improvement was seen with extension between 6 weeks and 3 months, where 26% of the extension at final follow-up was gained. Most of the recovery occurred within the first 3 months postoperatively, with small improvements thereafter. GMM and LCGA did not identify statistically significant groups for postoperative ROM progression trajectories. Arc of motion preoperatively, intraoperatively, and at 2 weeks postoperatively did not correlate with the final arc of motion. There were no demographic or historical characteristics, or thresholds of motion, which conferred a higher likelihood of achieving a better result postoperatively.ConclusionsROM recovery after surgical release for post-traumatic elbow stiffness did not depend on the preoperative, intraoperative, or 2-week postoperative arcs of motion. Most ROM recovery occurs early after surgery, and maximal arc of motion can be expected by approximately 16 weeks postoperatively. This knowledge may inform patients about their expected rehabilitation and splinting time and reduce the total costs of therapy.

Prevalence and associated factors of primary elbow osteoarthritis in the Japanese general elderly population: a Japanese cohort survey randomly sampled from a basic resident registry.

The epidemiology of primary elbow osteoarthritis (PEOA) remains unknown. We aimed to evaluate the prevalence and associated factors of PEOA in a cross-sectional resident cohort from a municipal registry of a Japanese town. A total of 415 residents over 50years of age were randomly sampled from a Japanese town and were adjusted for age and gender. Those with diseases that could potentially cause a secondary osteoarthritis of the elbow were excluded. The remaining 318 subjects (150 men and 168 women) underwent bidirectional radiography of the elbow. Subjects were diagnosed with PEOA if one of their elbows was Kellgren-Lawrence (KL) grade 2 or greater. In addition, motion pain and tenderness at the elbow were examined by orthopedic surgeons. Associated factors for the PEOA were statistically analyzed. The prevalence of PEOA was 25.2% (male, 27.3%; female, 23.2%), and the prevalence of symptomatic PEOA was 0.9%. The age-stratified prevalence of PEOA was as follows: 50-59, 6.2% (male, 5.0%; female, 7.3%); 60-69, 15.4% (male, 17.5%; female, 13.7%); 70-79, 29.5% (male, 35.3%; female, 25.0%); and 80-89, 55.9% (male, 55.6%; female, 56.3%). Age and body mass index were revealed as associated factors that increased the prevalence of PEOA with KL grade 2 or greater. The use of vibrating tools was demonstrated as an independent associated factor that increased the prevalence of PEOA with KL grade 4 in addition to the 2 aforementioned factors. The prevalence of PEOA in Japanese subjects was 25.2% for those aged 50-89 years with a mean age of 69.2years, most of which was asymptomatic OA without motion pain or tenderness at the elbow. Age and body mass index increased the prevalence of PEOA with KL grade 2 or greater. The prevalence of PEOA increased with age, but the disease was self-accommodated by most people.

Comparison of Clinical Outcomes between Arthroscopic Anterior Compartment Debridement with Posterior Compartment Mini-Open Debridement and Arthroscopic Both Compartments Debridement of the Primary Elbow Osteoarthritis

Comparison of Clinical Outcomes between Arthroscopic Anterior Compartment Debridement with Posterior Compartment Mini-Open Debridement and Arthroscopic Both Compartments Debridement of the Primary Elbow Osteoarthritis

Intraobserver and Interobserver Reliability of the Computed Tomography-Based Radiographic Classification of Primary Elbow Osteoarthritis: Comparison with Plain Radiograph-Based Classification and Clinical Assessment

Intraobserver and Interobserver Reliability of the Computed Tomography-Based Radiographic Classification of Primary Elbow Osteoarthritis: Comparison with Plain Radiograph-Based Classification and Clinical Assessment

Primary Elbow Osteoarthritis: Evaluation and Management

Most patients with primary osteoarthritis of the elbow report a history of heavy lifting with the affected upper extremity. Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drugs and the occasional intraarticular corticosteroid injection, may provide adequate pain relief in earlier stages. When surgery is required, and despite the presence of cartilage wear, many patients with primary elbow osteoarthritis experience substantial pain improvement with joint preserving procedures. The ulnar nerve needs to be carefully assessed and addressed at the time of surgery. Although open debridement procedures are effective, arthroscopic osteocapsular arthroplasty has emerged as the surgical procedure of choice. Total elbow arthroplasty is very successful in terms of pain relief and function, but it is reserved for patients with end-stage osteoarthritis who are relatively older and have failed joint preserving procedures.

Effectiveness of radiographs and computed tomography in evaluating primary elbow osteoarthritis

Preoperative radiographic assessment of osteophyte and loose body locations is critical in planning an arthroscopic débridement for primary elbow osteoarthritis. The purpose of this study was to evaluate the effectiveness of radiographs and computed tomography (CT) in localizing osteophytes and loose bodies. A consecutive series of 36 patients with primary elbow osteoarthritis was investigated with radiographs and multiaxial 2-dimensional CT prior to elbow arthroscopy. The location of osteophytes and loose bodies was assessed in 9 anatomic locations by 2 fellowship-trained upper extremity surgeons. The diagnostic effectiveness of both imaging modalities was evaluated by calculating the sensitivity and specificity and compared to the gold standard of elbow arthroscopy. Inter- and intrarater percentage agreement between the observations was calculated using Kappa score. The mean sensitivity for detecting osteophytes in the 9 different anatomic locations was 46% with radiographs and 98% with CT, whereas the mean specificity was 66% and 21% for radiographs and CT, respectively. The mean sensitivity and specificity for loose body detection with radiography were 49% and 89%, respectively, whereas CT had a mean sensitivity of 98% and specificity of 47%. The overall inter-rater percentage agreement between the surgeons in detecting osteophytes and loose bodies on radiographs was 80% and 85%, respectively, whereas on CT it was 95% for detecting osteophytes and 91% for loose bodies. CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. The lower specificity of CT may be due to this imaging modality's ability to detect small osteophytes and loose bodies that may not be readily identified during elbow arthroscopy. Radiographs have an inferior inter-rater percentage agreement compared with CT. CT is a valuable preoperative investigation to assist surgeons in identifying the location of osteophytes and loose bodies in patients undergoing surgery for primary elbow osteoarthritis.

Two hundred and eight consecutive elbow arthroscopies – indications and complications analysis

Objectives: Elbow arthroscopy is a technically demanding procedure susceptible to complications. This study aims to analyse patient databases for indications and complications of elbow arthroscopy procedures performed in the Department of Orthopaedic Surgery of the University Hospital Centre Zagreb. The obtained results are compared to outcomes published in the relevant literature. ----- Methods: This retrospective study examines 208 consecutive elbow arthroscopy procedures performed by a single surgeon in a consistent manner during a 10-year period. Available records were systemically reviewed to determine the main diagnosis and postoperative complications by an examiner not involved in the patients’ care. ----- Results: In the period from 1st of January 2008 to 1st of January 2018, a total of 191 patients underwent surgery, including 135 males (70.68%). Seven patients (two males and five females) underwent elbow arthroscopy of both arms. Mean age at the time of the procedure was 38.86 years (range 4 – 70 years). A total of 198 cases pertained to primary arthroscopic procedures, while the other ten procedures were referred to reoperations of the same elbow. Predominant main diagnosis for the procedure in 25.76% of the patients was posttraumatic elbow contracture followed by primary elbow osteoarthritis in 22.73% of the patients. Complications rate based on the available information during the period was 9.59%. There were four minor and 15 major complications. All of the major complications required revision surgeries, which in seven cases meant repeating the arthroscopic procedure and in eight cases prompted an open elbow surgery. ----- Conclusion: The results of this study, substantiated by literature examples, show that elbow arthroscopy is a reliable and effective surgical method in treating various elbow conditions when performed in a consistent fashion. Complications rates after an elbow arthroscopy in the observed patient group are low and completely comparable with the results of other published studies.

Determination of the patient acceptable symptomatic state after osteocapsular arthroplasty for primary elbow osteoarthritis.

The study aimed (1) to determine patient acceptable symptomatic state (PASS) values for the pain visual analog scale (PVAS), range-of-motion (ROM) scale difference, Mayo Elbow Performance Score (MEPS), and Self-evaluation Elbow (SEE) following osteocapsular arthroplasty for primary elbow osteoarthritis and (2) to determine factors for achieving the PASS. The study analyzed retrospectively collected osteocapsular arthroplasty registry data from January 2010 to April 2019. Fifty patients were evaluated, and anchor questions for deriving PASS values were administered at a 1-year follow-up. PASS values for the PVAS score, ROM difference, MEPS, and SEE score were derived using a sensitivity- and specificity-based approach. Univariate and multivariate logistic regression analyses were performed to determine factors for achieving the PASS. A subgroup comparison analysis based on age was also conducted. The PASS value was 1.0 for the PVAS score, 15° for ROM difference, 75 for the MEPS, and 60 for the SEE score. Older age (≥65 years) showed significantly lower odds ratios for achieving the PASS for the PVAS score (0.888; 95% confidence interval, 0.804-0.981; P = .032) and ROM (0.861; 95% confidence interval, 0.760-0.976; P = .020). Reliable PASS values were derived for the PVAS score, ROM difference, MEPS, and SEE score after osteocapsular arthroplasty. The PASS values defined in this study can be implemented as clinically relevant targets in patients undergoing osteocapsular arthroplasty. An analysis of factors that affect clinical symptom improvement showed that older age (≥65 years) was significantly correlated with lower PASS values for the PVAS score and ROM.

Arthroscopic and open debridement in primary elbow osteoarthritis: a systematic review and meta-analysis.

Primary osteoarthritis (OA) of the elbow can cause disabling symptoms of pain, locking, stiffness, and a limitation in the range of motion. There is no consensus regarding the role of open and arthroscopic debridement in the treatment of symptomatic primary elbow OA. The aim of this study is to systematically review the outcome of surgical debridement. A preoperative/postoperative comparison will be made between the two surgical procedures.All studies reporting on debridement as treatment for primary elbow OA with a minimum of one-year follow-up were included. Outcome parameters were functional results, complications, and performance scores.Data were extracted from 21 articles. The arthroscopic group consisted of 286 elbows with a weighted mean follow-up of 40 ± 17 months (range, 16–75). The open group consisted of 300 elbows with a weighted mean follow-up of 55 ± 20 months (range, 19–85). Both procedures showed improvement in Mayo Elbow Performance Score (MEPS), range of motion (ROM) flexion-extension, and ROM pronation-supination. Only in ROM flexion was a statistically significant difference in improvement seen between the groups in favour of the open group. The arthroscopic group showed improvement in pain visual analogue scale (VAS) scores. Nothing could be stated about pain VAS scores in the open group due to a lack of data. In the arthroscopic group 18 complications (6%) were described, in the open group 29 complications (12%).Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate.Cite this article: EFORT Open Rev 2020;5:874-882. DOI: 10.1302/2058-5241.5.190095

The Clinical Impact of Different Approaches to Osteocapsular Debridement for Primary Osteoarthritis of the Elbow: A Systematic Review

Primary elbow osteoarthritis is a relatively rare disease, with symptomatic disease occurring in approximately 2% of the general population. However, incidence as high as 33% has been described in patients who commonly undergo arduous manual activity. Osteocapsular debridement has been described through various approaches with successful outcomes in patients with elbow arthritis and impingement symptoms. Despite suggested benefits of different approaches, there is insufficient evidence in the literature to date to demonstrate superiority of any approach. The purpose of this review was to compare the clinical results of different approaches to osteocapsular debridement for primary elbow osteoarthritis.

Arthroscopic treatment of elbow osteoarthritis

Elbow osteoarthritis chiefly affects heavy manual labourers and athletes and may be primary or post-traumatic. Arthroscopic debridement for primary elbow osteoarthritis reliably produces pain relief, motion range gains, and good functional outcomes. Total elbow arthroplasty, in contrast, is considered a salvage option in this patient population, as activities must be restricted to protect the implant. Here, we describe the operative technique used for arthroscopic elbow release in 87 patients with symptomatic elbow osteoarthritis included prospectively at 6 centres in a study that was conducted for a French Arthroscopy Society symposium and whose findings are reported elsewhere. The technique involves exploration of the anterior and posterior compartments with resection of motion-limiting osteophytes; clearing of the fossae; foreign body extraction; and treatment of the posterior and anterior capsule and of the lateral inclines. The indications of ulnar nerve release, radial head excision, release of the posterior band of the medial collateral ligament (MCL), and/or fenestration as described by Outerbridge-Kashiwagi are discussed. After 6 months, 93.5% of patients were satisfied with the procedure. No serious neurological complications were recorded. Wound healing was impaired in 4 patients, of whom 3 responded to local care; the remaining patient required open debridement for surgical-site infection. Complex regional pain syndrome developed in 3 patients. Ulnar nerve transposition was required secondarily in 1 patient and another patient had persistent dysesthesia after ulnar nerve release. This minimally invasive technique provides good short-term outcomes in primary elbow osteoarthritis and is associated with a low complication rate.

Ulnar neuropathy at the elbow in 413 Japanese patients: An assessment of pathological elbow lesions and neurological severity

BackgroundVarious pathological elbow lesions are often complicated with ulnar neuropathy at the elbow (UNE), although the precise pathology, incidence, and clinical and neurological features of these lesions have not been identified. We therefore investigated elbow pathology and neurological severity in Japanese patients with UNE. MethodsThe medical records of 457 Japanese UNE patients who were surgically treated among 6 hospitals were retrospectively examined. Eligible patients had UNE diagnosed by physical findings and nerve conduction studies according to the criteria of the American Association of Electrodiagnostic Medicine. The elbows were analyzed with regard to age, gender, occupation, pathology at the elbow, and severity of nerve palsy. ResultsA total of 398 patients with 413 UNE elbows of a mean age of 63 years (range: 15–87) met the inclusion criteria. UNE elbows were predominantly in male patients (69.0%). Overall, 310 elbows (75.1%) had 1 or more elbow lesions: 238 elbows (76.8%) had a single lesion and 72 elbows (23.3%) had 2 or more lesions. The most common lesion was primary elbow osteoarthritis (EOA) occurring in 54.5% of elbows, followed next by medial elbow ganglion in 8.5% and cubitus valgus in 6.5%. Most elbows with medial elbow ganglion or cubitus valgus were associated with EOA. Entrapment sites were at the cubital tunnel in 84.5%–91.3% of UNE elbows, regardless of an association with elbow lesion. The incidence of McGowan grade III lesion was 50.8% in elbows with primary EOA, which was higher than the 35.0% in elbows with no lesion. ConclusionsThis study revealed that UNE had various isolated or combined elbow lesions. In Japanese UNE, primary or secondary EOA was found in 62.2% of cases and severe motor weakness was noted in 47.2%. The incidences of EOA and severe ulnar nerve palsy in the Japanese UNE are higher than those in Caucasians. Level of evidenceLevel IV; Prognostic—Investigating the effect of a patient characteristic on the outcome of a disease; Case series.