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So SP, Kwak JM, Lee JB, Ben H, Alsaqri H, Koh KH, Jeon IH. Radiologically severe osteoarthritis is related to worse clinical outcomes after arthroscopic osteocapsular arthroplasty in primary elbow osteoarthritis at medium-term follow-up: a retrospective cohort study. J Shoulder Elbow Surg 2023; 32:2325-2332. [PMID: 37422129 DOI: 10.1016/j.jse.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 07/10/2023]
Abstract
HYPOTHESIS This study aimed to compare the clinical outcomes after arthroscopic osteocapsular arthroplasty (OCA) at medium-term follow-up according to the radiologic severity of primary elbow osteoarthritis (OA) and assess serial changes in clinical outcomes in each group. METHODS Patients treated from January 2010 to April 2019 with arthroscopic OCA for primary elbow OA with a minimum of 3 years' follow-up were retrospectively assessed regarding range of motion (ROM), visual analog scale (VAS) pain score, and Mayo Elbow Performance Score (MEPS) preoperatively, at short-term follow-up (3-12 months postoperatively), and at medium-term follow-up (≥3 years after surgery). Preoperative computed tomography was performed to evaluate the radiologic severity of OA using the Kwak classification. Clinical outcomes were compared according to the radiologic severity of OA by their absolute values and the number of patients achieving the patient acceptable symptomatic state (PASS). Serial changes in the clinical outcomes in each subgroup were also assessed. RESULTS Of the 43 patients, 14, 18, and 11 were classified as the stage I, II, and III groups, respectively; the mean follow-up duration was 71.3 ± 28.9 months, and the mean age was 56.5 ± 7.2 years. At medium-term follow-up, the stage I group had a better ROM arc (stage I, 114° ± 14°; stage II, 100° ± 23°; and stage III, 97° ± 20°; P = .067) and VAS pain score (stage I, 0.9 ± 1.3; stage II, 1.8 ± 2.1; and stage III, 2.4 ± 2.1; P = .168) than the stage II and III groups without reaching statistical significance, whereas the stage I group had a significantly better MEPS (stage I, 93.2 ± 7.5; stage II, 84.7 ± 11.9; and stage III, 78.6 ± 15.2; P = .017) than the stage III group. The percentages of patients achieving the PASS for the ROM arc (P = .684) and VAS pain score (P = .398) were comparable between the 3 groups; however, the percentage achieving the PASS for the MEPS was significantly higher in the stage I group than in the stage III group (100.0% vs. 54.5%, P = .016). During serial assessment, all clinical outcomes tended to improve at the short-term follow-up. Compared with the short-term period, the ROM arc tended to decrease at the medium-term follow-up whereas the VAS pain score and MEPS overall did not show significant changes. CONCLUSION After arthroscopic OCA, the stage I group showed an overall better ROM arc and pain score than the stage II and III groups at medium-term follow-up, whereas the stage I group showed a significantly better MEPS and higher percentage of patients achieving the PASS for the MEPS than the stage III group.
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Affiliation(s)
- Sang-Pil So
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu-si, Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Republic of Korea
| | - Hui Ben
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Republic of Korea.
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de Klerk HH, Verweij LPE, Sierevelt IN, Priester-Vink S, Hilgersom NFJ, Eygendaal D, van den Bekerom MPJ. Wide Range in Complication Rates Following Elbow Arthroscopy in Adult and Pediatric Patients: A Systematic Review. Arthroscopy 2023; 39:2363-2387. [PMID: 37146664 DOI: 10.1016/j.arthro.2023.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To perform a systematic review of complications associated with elbow arthroscopy in adults and children. METHODS A literature search was performed in the PubMed, EMBASE, and Cochrane databases. Studies reporting complications or reoperations after elbow arthroscopy with at least 5 patients were included. Based on the Nelson classification, the severity of complications was categorized as minor or major. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized clinical trials, and nonrandomized trials were assessed using the Methodological Items for Non-randomized Studies (MINORS) tool. RESULT A total of 114 articles were included with 18,892 arthroscopies (16,815 patients). A low risk of bias was seen for the randomized studies and a fair quality for the nonrandomized studies. Complication rates ranged from 0% to 71% (median 3%; 95% confidence interval [CI], 2.8%-3.3%), and reoperation rates from 0% to 59% (median 2%; 95% CI, 1.8%-2.2%). A total of 906 complications were observed, with transient nerve palsies (31%) as the most frequent complication. According to Nelson classification, 735 (81%) complications were minor and 171 (19%) major. Forty-nine studies reported complications in adults and 10 studies in children, showing a complication rate ranging from 0% to 27% (median 0%; 95% CI, 0%-0.4%) and 0% to 57% (median 1%; 95% CI, 0.4%-3.5%), respectively. A total of 125 complications were observed in adults, with transient nerve palsies (23%) as the most frequent complication, and 33 in children, with loose bodies after surgery (45%) as the most frequent complication. CONCLUSIONS Predominantly low-level evidence studies demonstrate varying complication rates (median 3%, range 0%-71%) and reoperation rates (median 2%, range 0%-59%) after elbow arthroscopy. Higher complication rates are observed after more complex surgery. The incidence and type of complications can aid surgeons in patient counseling and refining surgical techniques to further reduce the complication rates. LEVEL OF EVIDENCE Level IV; systematic review of Level I-IV studies.
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Affiliation(s)
- Huub H de Klerk
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, University Medical Center Groningen (UMCG) and Groningen University, Groningen, the Netherlands.
| | - Lukas P E Verweij
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Inger N Sierevelt
- Specialized Centre for Orthopedic Research and Education (SCORE), Xpert Clinics, Orthopedic Department, Amsterdam, the Netherlands; Department of Orthopaedics, Spaarne Gasthuis Academie, Hoofddorp, the Netherlands
| | - Simone Priester-Vink
- Medical Library, Department of Research and Epidemiology, OLVG, Amsterdam, the Netherlands
| | - Nick F J Hilgersom
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands; Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
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So SP, Kwak JM, Lee JB, Ben H, Alsaqri H, Kim KH, Koh KH, Jeon IH. Clinical Outcomes of Revision Arthroscopic Osteocapsular Arthroplasty in Primary Elbow Osteoarthritis: A Retrospective Cohort Study. Am J Sports Med 2023; 51:2050-2056. [PMID: 37212352 DOI: 10.1177/03635465231171542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
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.
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Affiliation(s)
- Sang-Pil So
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu-si, Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hui Ben
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Keun Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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So SP, Kwak JM, Lee JB, Ben H, Kim KH, Koh KH, Jeon IH. Serial Changes in Clinical Outcomes After Arthroscopic Osteocapsular Arthroplasty for Primary Elbow Osteoarthritis: A Medium-term Follow-up Study. Orthop J Sports Med 2023; 11:23259671231162398. [PMID: 37250740 PMCID: PMC10214057 DOI: 10.1177/23259671231162398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/19/2023] [Indexed: 05/31/2023] Open
Abstract
Background 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. Purpose 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. Study Design Case series; Level of evidence, 4. Methods 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. Results 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). Conclusion 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.
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Affiliation(s)
- Sang-Pil So
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery,
Uijeongbu Eulji Medical Center, Eulji University College of Medicine, Uijeongbu-si,
Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Hui Ben
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Keun Ho Kim
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Republic of
Korea
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毕 文, 郭 标, 许 健, 崔 红, 马 炜, 杨 东, 付 鹏, 刘 一, 田 进. [Effectiveness analysis of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:268-273. [PMID: 35293165 PMCID: PMC8923938 DOI: 10.7507/1002-1892.202109034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/13/2022] [Indexed: 01/24/2023]
Abstract
Objective To explore the effectiveness of computer-aided technology in the treatment of primary elbow osteoarthritis combined with stiffness under arthroscopy. Methods 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. Results 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). Conclusion Arthroscopic treatment of primary elbow osteoarthritis combined with stiffness using computer-aided technology can significantly reduce pain, achieve satisfactory functional recovery and reliable effectiveness.
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Affiliation(s)
- 文智 毕
- 蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 标 郭
- 蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 健 许
- 蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 红林 崔
- 蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 炜 马
- 蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 东强 杨
- 蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 鹏飞 付
- 蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 一军 刘
- 蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 进翔 田
- 蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang Hospital Affiliated to Bengbu Medical College (Fuyang People’s Hospital), Fuyang Anhui, 236000, P. R. China
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Shiode R, Oka K, Shigi A, Miyamura S, Tanaka H, Mae T, Murase T. Arthroscopic Debridement of Elbow Osteoarthritis Using CT-Based Computer-Aided Navigation Systems Is Accurate. Arthrosc Sports Med Rehabil 2021; 3:e1687-e1696. [PMID: 34977621 PMCID: PMC8689228 DOI: 10.1016/j.asmr.2021.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ryoya Shiode
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Address correspondence to Kunihiro Oka, M.D., Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Atsuo Shigi
- Yukioka Hospital Hand Center, Osaka-shi, Osaka, Japan
| | - Satoshi Miyamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Midterm outcomes and survivorship of arthroscopic elbow debridement: a comparison of posttraumatic versus primary degenerative osteoarthritis. JSES Int 2021; 6:175-181. [PMID: 35141693 PMCID: PMC8811417 DOI: 10.1016/j.jseint.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
The objective of this review is to summarize the surgical options for primary osteoarthritis of the elbow, reported clinical outcomes, and suggested indications in previous literatures. The surgical management of primary elbow arthritis has evolved because of an improved understanding of pathologic mechanisms and manifestations as well as the development of novel surgical techniques and devices. Osteocapsular arthroplasty (OCA), elbow debridement, distraction arthroplasty, and total elbow arthroplasty (TEA) have been employed for managing elbow osteoarthritis. Elbow debridement and OCA can be helpful in most cases of symptomatic elbow arthritis. TEA is usually recommended for end-stage arthritis in elderly patients after prosthetic implants have been in place for long periods or after complications. Distraction arthroplasty might find a place in the treatment of younger, active patients with end-stage arthritis.
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Affiliation(s)
- Jae-Man Kwak
- 65526Department of Orthopedic Surgery, Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, South Korea
| | - In-Ho Jeon
- 65526Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
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9
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Shigi A, Oka K, Tanaka H, Shiode R, Murase T. Utility of a 3-dimensionally printed color-coded bone model to visualize impinging osteophytes for arthroscopic débridement arthroplasty in elbow osteoarthritis. J Shoulder Elbow Surg 2021; 30:1152-1158. [PMID: 33486060 DOI: 10.1016/j.jse.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The identification and precise removal of bony impingement lesions during arthroscopic débridement arthroplasty for elbow osteoarthritis require a high level of experience and surgical skill. We have developed a new technique to identify impinging osteophytes on a computer display by simulating elbow motion using the multiple positions of 3-dimensional (3D) elbow models created from computed tomography data. Moreover, an actual color-coded 3D model indicating the impinging osteophytes was created with a 3D printer and was used as an intraoperative reference tool. This study aimed to verify the efficacy of these new technologies in arthroscopic débridement for elbow osteoarthritis. METHODS We retrospectively studied 16 patients treated with arthroscopic débridement for elbow osteoarthritis after a preoperative computer simulation. Patients who underwent surgery with only the preoperative simulation were assigned to group 1 (n = 8), whereas those on whom we operated using a color-coded 3D bone model created from the preoperative simulation were assigned to group 2 (n = 8). Elbow extension and flexion range of motion (ROM), the Mayo Elbow Performance Score (MEPS), and the severity of osteoarthritis were compared between the groups. RESULTS Although preoperative elbow flexion and MEPS values were not significantly different between the groups, preoperative extension was significantly more restricted in group 2 than in group 1 (P = .0131). Group 2 tended to include more severe cases according to the Hastings-Rettig classification (P = .0693). ROM and MEPS values were improved in all cases. No significant differences in postoperative ROM or MEPS values were observed between the groups. There were no significant differences in the improvement in ROM or MEPS values between the 2 groups. CONCLUSIONS The use of preoperative simulation and a color-coded bone model could help to achieve as good postoperative ROM and MEPS values for advanced elbow osteoarthritis as those for early and intermediate stages.
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Affiliation(s)
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ryoya Shiode
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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White CHR, Ravi V, Watson J, Badhrinarayanan S, Phadnis J. A Systematic Review of Arthroscopic Versus Open Debridement of the Arthritic Elbow. Arthroscopy 2021; 37:747-758.e1. [PMID: 32949630 DOI: 10.1016/j.arthro.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the available data with regard to clinical and functional outcomes of arthroscopic and open debridement for elbow arthritis to determine the complication rate with transition to arthroscopic surgery. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses protocol, a systematic review was performed including studies reporting clinical and functional outcomes following open or arthroscopic debridement of elbow arthritis. The primary outcome measures analyzed were functional outcome (Mayo Elbow Performance Score), range of motion, and complication rate. Data were extracted for the whole group and then compared between the techniques using ranges and forest plots. RESULTS In total, 39 level IV and 3 level III studies with 1097 elbows were eligible for inclusion; 684 elbows were treated using an open technique and 413 using an arthroscopic technique. Regarding functional outcome scores, mean Mayo Elbow Performance Score improved significantly with comparable magnitude of improvement in both groups (arthroscopic group: range 28-34, open group: range 25-31). Regarding range of motion, mean flexion-extension arc improved significantly in both groups (arthroscopic group: range 8-26°, open group: range 13-49°). The open group had a lower preoperative flexion-extension arc (range 63-96) in comparison with the arthroscopic group (range 84-119). The overall incidence of complications was 5.7% (range 0%-19%) in the arthroscopic group and 6.1% (range 0%-25%) in the open group. The most common complication type was neurologic, with an incidence of 2.1% (range 0%-8%) in the arthroscopic group and 1.9% (range 0%-12%) in the open group. The deep infection rate was 0.7% (range 0%-10%) in the open group with no reported incidence in the arthroscopic group. CONCLUSIONS This systematic review demonstrated good mid-term functional outcomes following debridement arthroplasty of the arthritic elbow. There was no increase in complications with an arthroscopic technique confirming its safety and efficacy. LEVEL OF EVIDENCE IV, Systematic Review of Level III and IV articles.
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Affiliation(s)
| | - Vinayak Ravi
- Brighton and Sussex Medical School, Brighton, United Kingdom.
| | - Jay Watson
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton, United Kingdom
| | | | - Joideep Phadnis
- Brighton and Sussex Medical School, Brighton, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton, United Kingdom
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11
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de Klerk HH, Welsink CL, Spaans AJ, Verweij LPE, van den Bekerom MPJ. Arthroscopic and open debridement in primary elbow osteoarthritis: a systematic review and meta-analysis. EFORT Open Rev 2020; 5:874-882. [PMID: 33425376 PMCID: PMC7784140 DOI: 10.1302/2058-5241.5.190095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
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
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Affiliation(s)
- Huub H de Klerk
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | | | - Anne J Spaans
- Department of Orthopaedic Surgery, St Maartenskliniek, Nijmegen/Boxmeer, The Netherlands
| | - Lukas P E Verweij
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences (AMS), Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.,Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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12
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Guerrero EM, Bullock GS, Helmkamp JK, Madrid A, Ledbetter L, Richard MJ, Garrigues GE. The clinical impact of arthroscopic vs. open osteocapsular débridement for primary osteoarthritis of the elbow: a systematic review. J Shoulder Elbow Surg 2020; 29:689-698. [PMID: 32197763 DOI: 10.1016/j.jse.2019.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary elbow osteoarthritis (PEOA) is a debilitating disease that can be difficult to treat. Osteocapsular débridement (OD) has been described through various approaches, including arthroscopic and open approaches, with successful outcomes in treating PEOA. There is insufficient evidence in the literature to date to demonstrate the superiority of any approach. The purpose of this review was to compare the clinical results of arthroscopic vs. open OD for PEOA. METHODS The online databases PubMed, Embase (Elsevier), and Scopus (Elsevier) were searched from inception through April 1, 2018, for clinical studies reporting on OD. Studies were stratified based on an arthroscopic vs. open approach. Weighted means were calculated for surgical and patient-reported outcomes. RESULTS We included 30 studies, reporting on 871 patients and 887 elbows, with a mean follow-up period of 44.3 ± 25.5 months. Of these studies, 15 (420 elbows) reported on open OD, 14 (456 elbows) reported arthroscopic OD, and 1 reported on a cohort of each approach (open in 5 elbows and arthroscopic in 6). The Mayo Elbow Performance Score improved by 28.6 ± 4.57 in the open group vs. 26.6 ± 7.24 in the arthroscopic group. Flexion improved by 19° ± 6° in the open group and 10° ± 6° in the arthroscopic group. Extension improved by 11° ± 5° in the open group and 11° ± 6° in the arthroscopic group. CONCLUSIONS Open OD and arthroscopic OD are effective surgical treatment options for patients with symptomatic PEOA, reliably improving flexion, extension, and functional outcome scores with low complication rates.
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Affiliation(s)
- Evan M Guerrero
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Garrett S Bullock
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Joshua K Helmkamp
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Andres Madrid
- School of Medicine, University of Nevada, Reno, Reno, NV, USA
| | | | - Marc J Richard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
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13
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Karelson M, Launonen AP, Jokihaara J, Havulinna J, Mattila VM. Pain, function, and patient satisfaction after arthroscopic treatment of elbow in a retrospective series with minimum of 5-year follow-up. J Orthop Surg (Hong Kong) 2020; 27:2309499019832808. [PMID: 30827185 DOI: 10.1177/2309499019832808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The clinical indications for elbow arthroscopic procedures have expanded through last decades. The aim of the study was to assess the functional results and patient satisfaction after arthroscopic treatment of various elbow conditions after a minimum 5-year follow-up. METHODS We conducted a retrospective study of a consecutive patient cohort who had undergone unilateral elbow arthroscopy between 2008 and 2010. The main outcomes were Disabilities of the Arm, Shoulder and Hand (DASH) score and a specific patient-reported outcome measure questionnaire after a minimum 5-year follow-up. RESULTS In total, there were 93 patients in the cohort with different diagnoses. Majority of patients were suffering from elbow osteoarthrosis. After the average follow-up of 72 months (range 60-96 months), the response rate was 67%. Eighty two percent of patients were satisfied with the pain relief and locking of the elbow was relieved in 70% of patients. Elbow range of motion (ROM) improved in 80% of the 55 patients who had a limited ROM before the operation. The overall patient satisfaction after elbow arthroscopic treatment was good. There were no differences in median DASH score between patients with or without post-traumatic condition, but the median DASH score for patients who had severe (grade 3) osteoarthrosis before the operation was significantly worse. There were no major complications reported in this cohort. CONCLUSIONS Arthroscopic treatment of various elbow conditions was associated with good patient satisfaction and reduced symptoms without major complications. Level of Evidence: Level IV, therapeutic case series.
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Affiliation(s)
- Margit Karelson
- 1 Department of Hand Surgery, Tampere University Hospital, Tampere, Finland
| | - Antti P Launonen
- 2 Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- 1 Department of Hand Surgery, Tampere University Hospital, Tampere, Finland.,3 The School of Medicine, University of Tampere, Tampere, Finland
| | | | - Ville M Mattila
- 2 Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.,3 The School of Medicine, University of Tampere, Tampere, Finland
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14
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Desmoineaux P, Carlier Y, Mansat P, Bleton R, Rouleau DM, Duparc F. Arthroscopic treatment of elbow osteoarthritis. Orthop Traumatol Surg Res 2019; 105:S235-S240. [PMID: 31558411 DOI: 10.1016/j.otsr.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Pierre Desmoineaux
- Service de chirurgie orthopédique et traumatologique, hôpital Andre-Mignot, CHR de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France.
| | - Yacine Carlier
- Centre de l'Arthrose, clinique du sport Bordeaux Mérignac, 2, rue George-Négrevergne, 33700 Mérignac, France
| | - Pierre Mansat
- Département d'orthopédie-traumatologie, hôpital Pierre-Paul-Riquet, clinique universitaire du Sport, CHU-Purpan Toulouse, place du Dr Baylac, 31059 Toulouse, France
| | - Rémy Bleton
- Clinique Les Martinets - Ramsay Générale de Santé, 97, avenue Albert 1(er), 92500 Rueil-Malmaison, France
| | - Dominique M Rouleau
- Hôpital du Sacré-Coeur de Montréal, 5400, boulevard Gouin-Ouest, Montréal, QC, Canada
| | - Fabrice Duparc
- Service de chirurgie orthopédique et traumatologique, CHU Charles-Nicolle, 37, boulevard Gambetta, 76031 Rouen, France
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- 15, rue Ampère, 92500 Rueil-Malmaison, France
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15
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Validation of the registration accuracy of navigation-assisted arthroscopic débridement for elbow osteoarthritis. J Shoulder Elbow Surg 2019; 28:2400-2408. [PMID: 31445788 DOI: 10.1016/j.jse.2019.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The identification and precise removal of bony impingement lesions during arthroscopic débridement arthroplasty for elbow osteoarthritis is technically difficult. Surgical navigation systems, combined with preoperative 3-dimensional (3D) assessment of bony impingements, can provide real-time tracking of the surgical instruments and impingement lesions. This study aims to determine the registration accuracy of the navigation system for the humerus and ulna during elbow arthroscopy. METHODS We tested the registration procedure using resin bone models of 3 actual patients with elbow osteoarthritis. We digitized bone surface points using navigation pointers under arthroscopy. We initially performed paired-point registration, digitizing 6 preset anatomical landmarks, and then refined the initial alignment with surface matching registration, digitizing 30 points. The registration accuracy for each trial was evaluated as the mean target registration error in each reference marker. Three observers repeated the registration procedure 5 times each with the 3 specimens (total, 45 trials). The median of the registration accuracy was evaluated in total (45 trials) as the accuracy of the registration procedure. The differences in the registration accuracy among the 3 observers (median of 15 trials) were also examined. RESULTS The total registration accuracies were 0.96 mm for the humerus and 0.85 mm for the ulna. No significant differences were found in the registration accuracy for the humerus and ulna among the 3 observers. CONCLUSIONS This arthroscopic-assisted registration procedure is sufficiently feasible and accurate for application of the navigation system to arthroscopic débridement arthroplasty in clinical settings.
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16
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Kwak JM, Kholinne E, Sun Y, Alhazmi AM, Koh KH, Jeon IH. Intraobserver and interobserver reliability of the computed tomography-based radiographic classification of primary elbow osteoarthritis: comparison with plain radiograph-based classification and clinical assessment. Osteoarthritis Cartilage 2019; 27:1057-1063. [PMID: 30922981 DOI: 10.1016/j.joca.2019.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 03/02/2019] [Accepted: 03/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop a staging system that could better reflect symptoms by the spurs quantification in the fossa and joint space narrowing using computed tomography (CT) for elbow arthritis and to evaluate its reproducibility with multiple readers. METHODS This retrospective study evaluated 81 cases of primary elbow osteoarthritis using both plain radiography and CT. Qualitative and quantitative analyses were independently performed by four orthopedic surgeons using previous and newly proposed staging systems. The reproducibility of the new system was analyzed with intraclass correlation coefficients (ICC). Correlations between symptoms and radiologic classification were assessed using Pearson's correlation coefficient (PCC). RESULTS The interobserver agreement (1) and intraobserver agreement (2) among the four evaluators was present by ICC. (1) The system of Hastings and Rettig [first observation, 0.544 (95% confidence interval (CI), 0.436-0.649); second observation, 0.582 (95% CI, 0.478-0.682)] and Broberg and Morrey's staging system [first observation, 0.620 (95% CI, 0.521-0.714); second observation, 0.656 (95% CI, 0.562-0.743)] showed substantial and moderate retrospective agreement, whereas the CT-based staging system showed almost perfect agreement [first observation, 0.867 (95% CI, 0.820-0.906); second observation, 0.909 (95% CI, 0.875-0.936)]. (2) The intraobserver agreement was almost perfect in the Brogerg and Morrey's and CT-based staging systems. CT-based staging showed high correlation with visual analogue scale (PCC 0.754, P < 0.001) and Mayo elbow performance score (PCC -0.614, P < 0.001) and moderate correlation with range of motion (PCC -0.458, P < 0.001). CONCLUSIONS CT-based staging system was highly reproducible and clinically feasible than previous plain radiograph-based staging systems.
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Affiliation(s)
- J-M Kwak
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
| | - E Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Y Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - A M Alhazmi
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
| | - K-H Koh
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
| | - I-H Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea.
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17
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Kwak JM, Kholinne E, Sun Y, Lim S, Koh KH, Jeon IH. Clinical Outcome of Osteocapsular Arthroplasty for Primary Osteoarthritis of the Elbow: Comparison of Arthroscopic and Open Procedure. Arthroscopy 2019; 35:1083-1089. [PMID: 30871900 DOI: 10.1016/j.arthro.2018.11.057] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical and radiologic outcomes following open (OPEN) and arthroscopic (ARTHRO) osteocapsular arthroplasty for primary elbow osteoarthritis. METHODS Patients treated with osteocapsular arthroplasty between January 2010 and December 2015 were divided into OPEN and ARTHRO groups. OPEN was performed from January 2010 to October 2012, and ARTHRO from November 2012 to December 2015. OPEN and ARTHRO were performed in 35 and 52 elbows, respectively. Clinical outcome was measured using range of motion (ROM) arc, functional score (Mayo Elbow Performance Score [MEPS]), and pain score (visual analog scale [VAS]). Conventional radiography was used for outcome analysis. Outcomes were analyzed according to ulnohumeral joint (UHJ) narrowing using the computed tomography-based modified Broberg and Morrey classification. RESULTS Mean follow-up time was 36.6 ± 14.4 (24-89) and 35.4 ± 14.2 (24-83) months following OPEN and ARTHRO, respectively. Average ages were 50.0 ± 7.0 (40-63) and 52.4+10.4 (41-75) years in OPEN and ARTHRO groups, respectively. Overall scores for ROM (preoperative to final follow-up: 65.5° ± 22.8 to 112.0° ± 50.9, P < .01), MEPS (42.9 ± 13.7 to 73.7 ± 16.6, P < .01), and VAS (6.6 ± 1.3 to 4.0 ± 2.3, P < .01) were improved. Preoperative ROM improved from 64.0° ± 23.3 to 118.0° ± 17.8 following OPEN and 66.5° ± 22.6 to 108.0° ± 24.0 following ARTHRO. Preoperative MEPS improved from 40.7 ± 15.6 to 73.6 ± 16.7 following OPEN and 44.3 ± 12.2 to 73.8 ± 16.7 following ARTHRO. Preoperative VAS improved from 6.9 ± 1.2 to 3.9 ± 2.6 following OPEN and 6.4 ± 1.3 to 4.1 ± 2.0 following arthro. In both groups, the last follow-up VAS score and MEPS were worse in the narrowing group (UHJ <2 mm, grades 2 and 3) than in the intact group (UHJ >2 mm, grade 1) (P < .01). CONCLUSIONS Arthroscopic osteocapsular arthroplasty is comparable to the OPEN procedure in managing primary osteoarthritis of the elbow; however, the OPEN procedure shows the better outcome in improvement of flexion limitation. Neither procedures can guarantee an excellent outcome in the patients with severe UHJ narrowing. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea; Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Yucheng Sun
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
| | - Sungjoon Lim
- Department of Orthopedic Surgery, Uijeongbu St. Mary`s Hospital, The Catholic University, Seoul, South Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, South Korea.
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18
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Poonit K, Zhou X, Zhao B, Sun C, Yao C, Zhang F, Zheng J, Yan H. Treatment of osteoarthritis of the elbow with open or arthroscopic debridement: a narrative review. BMC Musculoskelet Disord 2018; 19:394. [PMID: 30414617 PMCID: PMC6234784 DOI: 10.1186/s12891-018-2318-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elbow osteoarthritis (OA) is a common disabling condition because of pain and loss of motion. Open and arthroscopic debridement are the preferred treatment, however there is no consensus on which treatment modality is suited to which category of patient or stage of disease. The objective of this study was to narratively review the literature for a more comprehensive understanding of its treatment options and associated outcomes, trying to provide a better treatment plan. METHODS The PubMed database, EMBASE, Cochrane Library, and Google Scholar were searched, using the keywords (elbow [title/abstract] and osteoarthritis [title/abstract] and (surgery or open or arthroscop* or debridement or ulnohumeral arthroplasty) including all possible studies with a set of inclusion and exclusion criteria. RESULTS A total of 229 studies were identified. Twenty-one articles published between 1994 and 2016 satisfied the inclusion and exclusion criteria including 651 elbows in 639 patients. After comparison, mean postoperative improvement in (ROM) was 28.6° and 23.3°,Mayo elbow performance score/index(MEPS/MEPI) 31 and 26.8 and the total complication rate was 37(11.5%), and 18(5.5%) for open and arthroscopic procedure. CONCLUSIONS This narrative review could not provide an insight on which surgical procedure is superior to the other due to the poor orthopedics literature. However, from the data we obtained the open and arthroscopic debridement procedures seem to be safe and effective in the treatment of elbow OA. The optimal surgical intervention for the treatment of symptomatic elbow OA should be determined depending on patients' conditions.
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Affiliation(s)
- Keshav Poonit
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Orthopedics of Zhejiang Province Wenzhou, China, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325027 Zhejiang Province China
| | - Xijie Zhou
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Orthopedics of Zhejiang Province Wenzhou, China, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325027 Zhejiang Province China
| | - Bin Zhao
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Orthopedics of Zhejiang Province Wenzhou, China, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325027 Zhejiang Province China
| | - Chao Sun
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Orthopedics of Zhejiang Province Wenzhou, China, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325027 Zhejiang Province China
| | - Chenglun Yao
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Orthopedics of Zhejiang Province Wenzhou, China, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325027 Zhejiang Province China
| | - Feng Zhang
- Joseph M. Still Burn and Reconstructive Center, 346 Crossgates Blvd, Suite, Brandon, MS 202 USA
| | - Jingwei Zheng
- Department of Clinical Research Center, The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hede Yan
- Department of Orthopedics (Division of Plastic and Hand Surgery), The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Key Laboratory of Orthopedics of Zhejiang Province Wenzhou, China, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325027 Zhejiang Province China
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19
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[Bony contact in arthritic and healthy elbow joints : Studies in cadaveric specimens]. DER ORTHOPADE 2018; 48:125-129. [PMID: 30194631 DOI: 10.1007/s00132-018-3634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Arthroscopic and open debridement arthroplasty for elbow arthrosis produce excellent results. Resection of the tip of the olecranon and coronoid, as well as debridement of the associated fossae, is frequently described as sufficient for restoring range of motion and reducing pain. OBJECTIVES The purpose of this study was to demonstrate that medial and lateral osteophytes of the olecranon and the coronoid usually mark the first bony contact and may, therefore, restrict range of motion. MATERIAL AND METHODS 11 fresh-frozen elbows were dissected. The fossae were coated with Optosil P Plus (C-silicone), and maximal flexion and extension was simulated. The distribution of C‑silicone impressions was documented. 6/7 donors were male. The mean age at the time of death was 82 . RESULTS Out of 11 elbows, 4 exhibited arthritic changes. All arthritic elbows showed marginal osteophytes of the olecranon without characteristic dipping of the olecranon into its fossa. In 1/4 cases, additional osteophytes at the side of the coronoid were detected (in comparison to 1/7 in healthy elbows). CONCLUSION The distribution of osteophytes in elbow arthrosis may be underestimated. Many clinicians describe a resection of the tip of the olecranon and the coronoid and debridement of the related fossa as sufficient. Our study supports the theory that marginal osteophytes, especially of the olecranon, should be resected during debridement arthroplasty, since the distribution of bony contact differs in arthritic and healthy elbows.
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20
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Isa AD, Athwal GS, King GJW, MacDermid JC, Faber KJ. Arthroscopic debridement for primary elbow osteoarthritis with and without capsulectomy: a comparative cohort study. Shoulder Elbow 2018; 10:223-231. [PMID: 29796111 PMCID: PMC5960874 DOI: 10.1177/1758573217726429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/24/2017] [Accepted: 07/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic elbow debridement for primary osteoarthritis may be performed with or without a joint capsulectomy. The purpose of this comparative cohort study was to compare range of motion (ROM) and early complications between patients with and without anterior capsulectomy. METHODS In total, 110 patients with primary osteoarthritis of the elbow who underwent an arthroscopic debridement for primary osteoarthritis were reviewed with a minimum of 3 months postoperative follow-up. The first group consisted of 51 patients who had a concomitant capsulectomy and the second group consisted of 59 patients who either had a capsulotomy or did not have the capsule addressed. RESULTS There was significantly greater pre-operative stiffness in the group who had an anterior capsulectomy versus those who did not. A greater improvement in arc of ROM occurred in patients who had a concomitant capsulectomy compared to patients without (24° versus 12°) (p < 0.003); however, there were no significant differences in final ROM between groups. There were no statistically significant differences in the incidence of complications between the groups (16% capsulectomy versus 18% no capsulectomy). CONCLUSIONS Elbow arthroscopy and debridement for primary elbow osteoarthritis yields satisfactory motion at short-term follow-up with or without a capsulectomy. The incidence of early complications was low at this tertiary referral centre, with no significant differences between groups.
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Affiliation(s)
- Ahaoiza D Isa
- Ahaoiza D. Isa, Roth McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, 268 Grosvenor Street, London, ON N6A 4V2, Canada.
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Zhang L, Guan T, Qi J, Zhang S, Zhou X, Liu Y, Fu S. A model of anterior cruciate ligament injury in cynomolgus monkeys developed via arthroscopic surgery. Exp Ther Med 2018; 15:2239-2246. [PMID: 29456631 PMCID: PMC5795381 DOI: 10.3892/etm.2018.5722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/05/2018] [Indexed: 12/16/2022] Open
Abstract
The anterior cruciate ligament (ACL) is an important structure that maintains the stability of knee joints. Animal models of ACL injury are helpful to explore its underlying mechanisms, and strategies for prevention, treatment and rehabilitation. Therefore, the aim of the present study was to develop an efficient model of ACL injury in cynomolgus monkeys via arthroscopic techniques. In the present study, 18 cynomolgus monkeys were randomly divided into a model group (n=6), a sham operation group (n=6) and a blank control group (n=6). One-quarter of the ACL was removed under arthroscopy in the model group. In the sham operation group, only arthroscopic exploration was performed as a control. In the blank control group, monkeys were housed under the same conditions for the same length of time. Magnetic resonance imaging examination was performed pre- and post-operatively, as well as measurements of the circumference of the thigh and calf, and of the maximum flexion degree of the knee. Anterior drawer test, Lachman test and pivot-shift tests were also performed. The results revealed that the injured side of the knees in the model group became unstable, as determined from evaluation of the physical tests. In conclusion, based on these findings, the modeling method of ACL injury was effective, and may contribute to the associated research concerning ACL injury.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Taiyuan Guan
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Ji Qi
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shaoqun Zhang
- Department of Orthopedics, School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yang Liu
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Shijie Fu
- Department of Orthopedics, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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Sochacki KR, Jack RA, Hirase T, McCulloch PC, Lintner DM, Liberman SR, Harris JD. Arthroscopic Debridement for Primary Degenerative Osteoarthritis of the Elbow Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic Review. Arthroscopy 2017; 33:2255-2262. [PMID: 29100769 DOI: 10.1016/j.arthro.2017.08.247] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this investigation was to determine whether arthroscopic debridement of primary elbow osteoarthritis results in statistically significant and clinically relevant improvement in (1) elbow range of motion and (2) clinical outcomes with (3) low complication and reoperation rates. METHODS A systematic review was registered with PROSPERO and performed using PRISMA guidelines. Databases were searched for studies that investigated the outcomes of arthroscopic debridement for the treatment of primary osteoarthritis of the elbow in adult human patients. Study methodological quality was analyzed. Studies that included post-traumatic arthritis were excluded. Elbow motion and all elbow-specific patient-reported outcome scores were eligible for analysis. Comparisons between preoperative and postoperative values from each study were made using 2-sample Z-tests (http://in-silico.net/tools/statistics/ztest) using a P value < .05. RESULTS Nine articles (209 subjects, 213 elbows, 187 males, 22 females, mean age 45.7 ± 7.1 years, mean follow-up 41.7 ± 16.3. months; 75% right, 25% left; 79% dominant elbow, 21% nondominant) were analyzed. Elbow extension (23.4°-10.7°, Δ 12.7°), flexion (115.9°-128.7°, Δ 12.8°), and global arc of motion (94.5°-117.6°, Δ 23.1°) had statistically significant and clinically relevant improvement following arthroscopic debridement (P < .0001 for all). There was also a statistically significant (P < .0001) and clinically relevant improvement in the Mayo Elbow Performance Score (60.7-84.6, Δ 23.9) postoperatively. Six patients (2.8%) had postoperative complications. Nine (4.2%) underwent reoperation. CONCLUSIONS Elbow arthroscopic debridement for primary degenerative osteoarthritis results in statistically significant and clinically relevant improvement in elbow range of motion and clinical outcomes with low complication and reoperation rates. LEVEL OF EVIDENCE Systematic review of level IV studies.
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Affiliation(s)
- Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Robert A Jack
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Takashi Hirase
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | | | - David M Lintner
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Shari R Liberman
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A..
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Abstract
Treatment of primary elbow osteoarthritis in the young active patient less than 50 years old presents a treatment challenge to the practicing orthopaedic surgeon. Following failure of nonoperative management, surgical goals are aimed at reducing pain and improving joint mobility from bony impingement. Arthroscopic osteocapsular arthroplasty is a viable treatment option with few post-operative limitations. In contrast, total elbow arthroplasty is considered a salvage option in this patient population given the activity restrictions imposed. Osteocapsular arthroplasty combines soft tissue and bony debridement, osteophyte/loose body removal, synovectomy, capsular release, and bony contouring of the humerus and ulna to allow impingement-free range of motion.
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Abstract
The incidence of osteoarthritis in the general population is low, but it can be seen in manual laborers, throwing athletes, and people dependent on crutches and wheelchairs. Patients often complain of pain at the terminal extents of motion, and imaging shows osteophyte formation at the tips of the coronoid and olecranon processes as well as thickening of the bone between the coronoid and the olecranon fossae. Recent advances in arthroscopic instrumentation and techniques have led to a growing interest in the arthroscopic treatment of elbow osteoarthritis. This article provides a review of basic arthroscopic elbow anatomy and the most common procedures, including diagnostic arthroscopy, loose body removal, and arthroscopic osteocapsular and ulnohumeral arthroplasty. As techniques advance, there might be interest in further procedures including arthroscopic-assisted interpositional arthroplasty. Although complications such as persistent drainage and nerve injury are frequently mentioned with elbow arthroscopy, the actual incidence of such complications remains low.
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