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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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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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3
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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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Ahmed AF, Alzobi OZ, Hantouly AT, Toubasi A, Farsakoury R, Alkhelaifi K, Zikria B. Complications of Elbow Arthroscopic Surgery: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221137863. [PMID: 36479463 PMCID: PMC9720815 DOI: 10.1177/23259671221137863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/30/2022] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Elbow arthroscopic surgery has been popularized and has made significant progress during the past 3 decades. The elbow joint is relatively small and is in close proximity to many neurovascular structures. These factors make elbow arthroscopic surgery technically demanding and liable to complications. PURPOSE To evaluate the rate of complications after elbow arthroscopic surgery. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis. PubMed, Web of Science, and Embase were searched up to July 2021. All clinical studies that reported complications after elbow arthroscopic surgery were included; a total of 1208 articles were initially found. Case reports, reviews, abstracts, imaging studies, technique studies, nonclinical studies, and those not reporting postoperative complications were excluded. Complication rates were pooled across studies and reported as percentages. Complications were expressed as weighted proportions with 95% CIs. RESULTS A total of 95 studies (14,289 elbows) were included in the meta-analysis. The overall weighted complication rate was 11.0% (95% CI, 8.8%-13.5%), with postoperative stiffness being the most commonly encountered complication (4.5% [95% CI, 2.1%-7.6%]; 158/8818 procedures). The second most encountered complication was the need for subsequent surgery with a weighted proportion of 4.1% (95% CI, 2.9%-5.6%; 177/8853 procedures) followed by nerve injury with a weighted proportion of 3.4% (95% CI, 2.6%-4.3%; 267/13,725 procedures). The ulnar nerve was the most commonly injured nerve (2.6% [95% CI, 1.9%-3.4%]; 123/6290 procedures). CONCLUSION The results of this study showed that elbow arthroscopic surgery is a relatively safe procedure with low complication rates.
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Affiliation(s)
- Abdulaziz F. Ahmed
- Division of Shoulder and Sports Medicine, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Osama Z. Alzobi
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf T. Hantouly
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ammar Toubasi
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Rana Farsakoury
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Bashir Zikria
- Division of Shoulder and Sports Medicine, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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5
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Beck CM, Gluck MJ, Zhang Y, McGough JD, Reizner W, Rubin TA, Hausman MR. Outcomes of Arthroscopic Elbow Contracture Release: Improvement for Severe Prosupination and Flexion Contracture. Arthroscopy 2022; 38:315-322. [PMID: 34329701 DOI: 10.1016/j.arthro.2021.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate outcomes following arthroscopic elbow contracture release to describe the use of arthroscopy for improvement in extension/flexion and pronation/supination arcs of motion at a single institution for degenerative and posttraumatic etiologies. METHODS Consecutive arthroscopic elbow arthrolysis performed between 2003 and 2015 were retrospectively reviewed. Basic patient demographics, indications for surgery, preoperative and postoperative elbow range of motion, postoperative patient outcome score, and all complications were recorded and analyzed. RESULTS Fifty-two patients were included with an average follow-up of 5.1 years (range 1.4 to 9.4). Severe contractures made up 50% of cases, followed by 23% moderate, and 27% mild. Average extension/flexion for the post-traumatic group (n = 30) increased by 63° ± 31 and by 29° ± 24 for the degenerative group (n = 22). Average gain in pronosupination was 38° ± 62 in the post-traumatic group and 13°±23 in the degenerative group. Postoperative DASH scores were 17.5 ± 18.4 for post-traumatic cases and 12.8 ± 19.3 for degenerative cases. CONCLUSION Arthroscopic elbow contracture release is an effective intervention for degenerative and post-traumatic elbow contracture for both flexion/extension and pronosupination contracture. Furthermore, a two-stage release should be considered when both flexion and pronosupinaton contractures are present. LEVEL OF EVIDENCE IV, case series, treatment study.
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Affiliation(s)
- Christina M Beck
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Matthew J Gluck
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A..
| | - Yiyang Zhang
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Joshua D McGough
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Wayne Reizner
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Todd A Rubin
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Michael R Hausman
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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6
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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: 0] [Impact Index Per Article: 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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Seah RB, Mak WK, Bryant K, Korlaet M, Dwyer A, Bain GI. Four-dimensional computed tomography scan for dynamic elbow disorders: recommendations for clinical utility. JSES Int 2021; 6:182-186. [PMID: 35141694 PMCID: PMC8811401 DOI: 10.1016/j.jseint.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Four-dimensional computed tomography (4D CT) is rapidly emerging as a diagnostic tool for the investigation of dynamic upper limb disorders. Dynamic elbow pathologies are challenging to diagnose, and at present, limitations exist in current imaging modalities Objective We aimed to assess the clinical utility of 4D CT in detecting potential dynamic elbow disorders. Methods Twenty-eight elbow joints from 26 patients with symptoms of dynamic elbow pathology were included in this study. They were first assessed by a senior orthopedic surgeon with subsequent qualitative data obtained via a Siemens Force Dual Source CT scanner (Erlangen, Germany), producing two- and three-dimensional “static” images and 4D dynamic “movie” images for assessment in each clinical scenario. Clinical assessment before and after scan was compared. Results Use of 4D CT scan resulted in a change of diagnosis in 16 cases (57.14%). This included a change in primary diagnosis in 2 cases (7.14%) and secondary diagnosis in 14 cases (50%). In 25 cases (89.29%), the 4D CT scan allowed us to understand the pathological anatomy in greater detail which led to a change in the management plan of 15 cases (53.57%). Conclusion 4D CT is a promising diagnostic tool in the management of dynamic elbow disorders and may be considered in clinical practice. Future studies need to compare it with other diagnostic modalities such as three-dimensional CT.
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Affiliation(s)
| | - Wai-Keong Mak
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
- Corresponding author: Wai-Keong Mak, MRCS, MBBS, 110 Sengkang E Way, Singapore 544886.
| | - Kimberley Bryant
- Clinical and Research Imaging Centre, SAHMRI, Adelaide, SA, Australia
| | - Mishelle Korlaet
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
| | - Andrew Dwyer
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
| | - Gregory I. Bain
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
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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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9
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Kim H, Kwak JM, Kholinne E, Kim DM, Park JH, Koh KH, Jeon IH. Determination of the patient acceptable symptomatic state after osteocapsular arthroplasty for primary elbow osteoarthritis. J Shoulder Elbow Surg 2021; 30:2127-2133. [PMID: 33529774 DOI: 10.1016/j.jse.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Hyojune Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Dong Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Park
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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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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11
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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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13
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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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Clinical outcomes of a combined arthroscopic and mini-open Outerbridge-Kashiwagi procedure for elbow osteoarthritis. J Shoulder Elbow Surg 2020; 29:2646-2653. [PMID: 33190762 DOI: 10.1016/j.jse.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND To evaluate the short-term clinical outcomes of a modified Outerbridge-Kashiwagi (O-K) procedure in the treatment of elbow osteoarthritis. METHODS Between January 2012 and December 2016, 27 patients with elbow osteoarthritis were treated with a modified O-K procedure combining mini-open and arthroscopic technique in our institution. All patients with primary osteoarthritis and post-traumatic degenerative osteoarthritis of the elbow were included in the study if they had undergone the modified O-K procedure. Clinical outcomes were assessed using the visual analog scale (VAS), degree of flexion, extension loss, arc of motion, Mayo Elbow Performance Score (MEPS), and radiographs. RESULTS Twenty-five patients with a mean age of 47.2 years (range, 21-69 years) at surgery were followed up for a mean of 54.5 months (range, 27-86 months). The VAS improved from 8.0 ± 1.4 (range, 6-10) preoperatively to 1.3 ± 1.1 (range, 0-3) at the final follow-up (P < .001), degree of flexion from 115.2° ± 12.0° (range, 90°-135°) to 130.6° ± 6.3° (range, 120°-140°) (P < .001), extension loss from 31.2° ± 15.0° (range, 10°-60°) to 10.2° ± 7.7° (range, 0°-30°) (P < .001), arc of motion from 84.0° ± 18.8° (range, 55°-120°) to 120.4° ± 9.3° (range, 105°-135°) (P < .001), and MEPS from 55.8 ± 8.1 (range, 40-70) to 88.4 ± 7.2 (range, 70-100) (P < .001). Radiographs at the final follow-up showed that 9 patients (36%) had significant recurrence of bone formation within the fenestration of the olecranon fossa. One patient developed delayed-onset ulnar neuropathy, with only slight numbness in the ulnar nerve distribution 6 months after surgery. CONCLUSIONS The modified O-K procedure is safe and effective in pain relief and function restoration in patients with elbow osteoarthritis.
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Kwak JM, Kim H, Sun Y, Kholinne E, Koh KH, Jeon IH. Arthroscopic osteocapsular arthroplasty for advanced-stage primary osteoarthritis of the elbow using a computed tomography-based classification. J Shoulder Elbow Surg 2020; 29:989-995. [PMID: 31831280 DOI: 10.1016/j.jse.2019.09.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Arthroscopic osteocapsular arthroplasty for stage III osteoarthritis (advanced stage) shows worse clinical and radiologic outcomes compared with stage I or II according to computed tomography (CT)-based classification. METHODS Clinical and radiologic outcomes in 65 patients treated with arthroscopic osteocapsular arthroplasty were retrospectively analyzed for range of motion (ROM) arc, functional score (Mayo Elbow Performance Score [MEPS]), and pain score (visual analog scale [VAS]). Patients were classified into stage I or II (n = 44) and stage III (n = 21) groups according to CT-based classification, and postoperative clinical outcomes and complications were analyzed. RESULTS Mean follow-up duration was 32.9 ± 13.7 months (range, 24-69). The average patient age was 52 ± 10 years (range, 40-63). Improvements from preoperative to final follow-up were seen in the overall ROM-flexion from 94° ± 19° to 129° ± 14° (P < .01), ROM-extension from 25° ± 12° to 14° ± 7° (P < .01), MEPS from 45 ± 13 to 78 ± 14 (P < .01), and VAS score from 6.3 ± 1.6 to 3.1 ± 1.4 (P < .01). Subgroup analysis using the CT-based classification revealed that stage III led to worsened VAS score and MEPS than stage I or II. CONCLUSIONS Arthroscopic osteocapsular arthroplasty can be recommended for its favorable overall treatment outcomes for elbow osteoarthritis. However, stage III shows worse clinical and radiologic outcomes compared with stage I or II according to CT-based classification.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea
| | - Yucheng Sun
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea; Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea; Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea.
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16
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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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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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Kim DM, Han M, Jeon IH, Shin MJ, Koh KH. Range-of-motion improvement and complication rate in open and arthroscopic osteocapsular arthroplasty for primary osteoarthritis of the elbow: a systematic review. INTERNATIONAL ORTHOPAEDICS 2020; 44:329-339. [PMID: 31834444 DOI: 10.1007/s00264-019-04458-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/27/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze ROM changes by using a Bayesian method, to compare complication and re-operation rates between open osteocapsular arthroplasty (OPEN) and arthroscopic osteocapsular arthroplasty (ARTHRO) for primary osteoarthritis of the elbow, and find evidence-based tendencies. METHODS The PubMed, Cochrane Library, and Embase databases were searched. We performed descriptive analysis to compare ARTHRO and OPEN, a Bayesian analysis of ROM changes, and methodological assessment to determine the tendencies of OPEN and ARTHRO. RESULTS Eighteen articles (625 patients, 634 elbows) were analyzed. There were 11 articles on OPEN and 8 articles on ARTHRO (1 article was a comparative study between OPEN and ARTHRO). According to the Bayesian method, flexion and total arc of flexion-extension increased more with OPEN than with ARTHRO. Further, ARTHRO showed a narrower width in the ROM graph than OPEN. The number of complications was 17 (5.1%) and five (2.0%), and the number of re-operations was 32 (9.5%) and 14 (5.6%) for OPEN and ARTHRO, respectively. By analyzing six high-quality articles, we found three tendencies: OPEN and ARTHRO were both effective for improving pain score, flexion-extension arc, and functional outcome; OPEN did not improve the pronation-supination arc; and there was a weak tendency that OPEN was more effective than ARTHRO for improving the flexion arc. CONCLUSION Both OPEN and ARTHRO improved ROM and clinical scores. The Bayesian method indicated that although OPEN increased the flexion and flexion-extension arc more than ARTHRO, ARTHRO resulted in a relatively consistent surgical outcome. Additionally, OPEN caused relatively higher complication and re-operation rates than ARTHRO.
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Affiliation(s)
- Dong Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, South Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, South Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, South Korea
| | - Myung Jin Shin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, South Korea
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05535, South Korea.
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Carlier Y, Lenoir H, Rouleau DM, Mansat P, Vidil A, Ferrand M, Bleton R, Herrisson O, Salabi V, Duparc F, Kelberine F, Desmoineaux P. Arthroscopic debridement for osteoarthritis of the elbow: Results and analysis of predictive factors. Orthop Traumatol Surg Res 2019; 105:S221-S227. [PMID: 31540887 DOI: 10.1016/j.otsr.2019.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoarthritis is the second most frequent cause of elbow stiffness, after trauma sequelae. Surgical treatment mainly consists of debridement. The main aim of the present study was to assess the efficacy of arthroscopic treatment of osteoarthritis of the elbow on Andrews-Carson score. Secondary objectives comprised assessment of the impact of associated procedures and of epidemiological factors on functional results. METHOD A prospective multicenter study involving 8 centers, in a symposium held by the French Society of Arthroscopy (SFA), included patients treated by arthroscopy for primary or secondary osteoarthritis of the elbow between January 2017 and March 2018, with a minimum 6 months' follow-up. Clinical assessment was based on change in Andrews-Carson functional score (AC), specific to osteoarthritis of the elbow, and on other functional scores: QuickDash (QD), Patient-Rated Elbow Evaluation (PREE), Mayo Elbow Performance Score (MEPS) and Self-Evaluation Elbow (SEE). Progression in pain on visual analog scale (VAS) and range of motion (RoM) was also assessed. Initial imaging work-up comprised standard X-ray and CT arthrography; paraclinical follow-up was based on X-ray. The impact of the following procedures associated to arthroscopic debridement was analyzed: radial head resection, ulnar nerve release, humeral fenestration, lateral ramp release, and medial collateral ligament posterior bundle release. The functional impact of epidemiological factors (age, handedness, manual occupation, smoking, body-mass index, and work accident/occupational disease status) and radiographic factors (foreign bodies, joint impingement, osteophytes, and fossa filling) was also assessed. RESULTS The series comprised 87 patients: 75 male (86.2%); mean age, 49 years (range, 18-73 years). Arthroscopic debridement significantly improved all functional scores at a minimum 6 months, and notably the specific AC score: 113.6±25.4 (40-180) versus 178.7±20.2 (110-200) (P<0.0001). Pain diminished significantly: 6.4±2.1 (0-10) versus 1.7±1.8 (0-8) (P<0.0001). RoM increased significantly: flexion/extension, 93.44±20.5° (5-130°) versus 124.2±13.8° (90-160°) (P<0.0001); pronation/supination, 147.6±25.6° (60-180°) versus 162.5±20.6° (100-180°) (P<0.0001). Strength (kg) increased in flexion (8.8±4.0 (4 to 20) versus 15.3±5.1 (3 to 32) (P<0.0008) and in grip [33.1±12.3 (10 to 58) versus 42.1±14.0 (2 to 68) (P<0.0001)]. Epidemiologically, males showed better recovery than females for both pain and strength. There was a significant positive impact of manual work on functional recovery, pain and also strength. There was a significant negative impact of work-accident/occupational disease on pain and strength. Regarding associated procedures, lateral ramp debridement improved AC score, with a gain of 75.4±25.3 points (-5 to 110) vs. 49.6±23.5 (10 to 100) (P<0.0001), and pain on VAS, with a fall of -5.6±2.1 points (-10 to -1) vs. -3.6±3.0 (-8.5 to 1) (P=0.0013). Ulnar nerve release, radial head resection and humeral fenestration had no positive impact. Preoperative foreign body was a factor for good prognosis. Cartilage wear, especially in the humeroulnar compartment, was associated with poorer functional results. DISCUSSION/CONCLUSION Arthroscopic treatment of osteoarthritis of the elbow significantly improved clinical results at 6 months, with significant improvements in functional scores, pain, strength and range of motion. Gender, type of work and work-accident/occupational disease status influenced clinical results. Lateral ramp release is an often overlooked technical factor improving functional results. Radiologically, the best candidates are those presenting with a foreign body and no humeroulnar impingement. LEVEL OF EVIDENCE III, Prospective observational multicenter cohort study.
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Affiliation(s)
- Yacine Carlier
- Clinique du sport Bordeaux-Mérignac, centre de l'Arthrose, 2, rue George-Négrevergne, 33700 Mérignac, France.
| | - Hubert Lenoir
- Chirurgie de l'épaule, du coude et de la main, centre ostéo-articulaire des Cèdres, Parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France
| | - Dominique M Rouleau
- Hôpital du Sacré-Coeur de Montréal, 5400, boulevard Gouin Ouest, Montréal, Québec, Canada
| | - Pierre Mansat
- Département d'orthopédie-traumatologie, hôpital Pierre Paul-Riquet, clinique universitaire du Sport, CHU de Purpan Toulouse, Place du Dr Baylac, 31059 Toulouse, France
| | - Anne Vidil
- Clinique Bizet, institut Parisien de l'épaule, 22, bis rue Georges-Bizet, 75116 Paris, France
| | - Matthieu Ferrand
- Institut locomoteur de l'Ouest, CHP de Saint-Grégoire-Vivalto Santé, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Rémy Bleton
- Clinique les Martinets-Ramsay Générale de santé, 97, avenue Albert 1(er), 92500 Rueil-Malmaison, France
| | - Olivier Herrisson
- Service de chirurgie orthopédique et traumatologie, hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Vincent Salabi
- GHI Le Raincy Montfermeil, 10, rue du Général Leclerc, 93370 Montfermeil, France
| | - Fabrice Duparc
- Service de chirurgie orthopédique et traumatologique, CHU de Charles-Nicolle, 37, boulevard Gambetta, 76031 Rouen, France
| | - François Kelberine
- Clinique Provençale Parc Rambot, 67, Cours Gambetta, 13100 Aix-en-Provence, France
| | - Pierre Desmoineaux
- Service de chirurgie orthopédique et traumatologique, hôpital André-Mignot, CHR de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
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Kwak JM, Sun Y, Kholinne E, Koh KH, Jeon IH. Surgical outcomes for post-traumatic stiffness after elbow fracture: comparison between open and arthroscopic procedures for intra- and extra-articular elbow fractures. J Shoulder Elbow Surg 2019; 28:1998-2006. [PMID: 31540725 DOI: 10.1016/j.jse.2019.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We hypothesized that arthroscopic osteocapsular arthroplasty has a comparable outcome to that of the corresponding open procedure. METHODS Patients treated with osteocapsular arthroplasty for post-traumatic stiffness were assigned to open procedure (OPEN) and arthroscopic procedure (ARTHRO) groups. The clinical outcomes were measured based on range of motion (ROM), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) score. Based on the initial trauma, the patients were grouped into either intra-articular fracture (I) or extra-articular fracture (E) groups, followed by comparison of the 2 groups. RESULTS The overall, ROM, VAS, and MEPS scores showed improvement in both groups. Preoperative VAS scores improved from 6.6 ± 1.4 to 2.2 ± 0.9 following OPEN and from 6.5 ± 1.2 to 2.1 ± 1.0 following ARTHRO. Preoperative flexion improved from 88° ± 14° to 113° ± 17° following OPEN and from 102° ± 15° to 122° ± 8° following ARTHRO. Preoperative extension improved from 36° ± 14° to 17° ± 12° following OPEN and from 30° ± 8° to 15° ± 7.4° following ARTHRO. Preoperative MEPS improved from 48.9 ± 11.5 to 80.0 ± 14.8 following OPEN and from 52.3 ± 12.2 to 80.8 ± 7.9 following ARTHRO. All values for the clinical outcomes were worse in group I than in group E. CONCLUSIONS Arthroscopic osteocapsular arthroplasty is comparable to the corresponding open procedure with regard to the use of our indications. The clinical outcomes in the intra-articular fracture group as a previous trauma were worse than those in the extra-articular fracture group.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea
| | - Yucheng Sun
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea; Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea; Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea.
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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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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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[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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Lubiatowski P, Ślęzak M, Wałecka J, Bręborowicz M, Romanowski L. Prospective outcome assessment of arthroscopic arthrolysis for traumatic and degenerative elbow contracture. J Shoulder Elbow Surg 2018; 27:e269-e278. [PMID: 29752151 DOI: 10.1016/j.jse.2018.02.068] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/18/2018] [Accepted: 02/28/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy of arthroscopic elbow release for both traumatic and degenerative contractures from intraoperative recording through the recovery time until final follow-up. METHODS The study is based on 54 consecutive patients with extrinsic elbow contracture (traumatic in 31 and degenerative in 23) treated with arthroscopic arthrolysis by a single surgeon in 2011-2015. Range of motion (ROM) and the Mayo Elbow Performance Score (MEPS) were recorded preoperatively; intraoperatively; following release; and in the 1st, 3rd, 8th, 12th, and 26th weeks and at 2 years postoperatively. RESULTS Significant improvements were noted in extension, flexion, and range of motion, measured both intraoperatively and at all follow-up visits. The greatest improvement in the range of motion was achieved at the time of surgery (from 89° ± 28° to 131° ± 14°, P < .001); it then decreased at 1 week to 103° ± 22° (P < .001) and slowly recovered to reach 124° ± 22° after 2 years. This was better than the preoperative value (P < .001) but worse than the intraoperative value (P = .002). A similar pattern was observed in both traumatic and degenerative contractures. The MEPS improved from 73 ± 12 preoperatively to 93 ± 14 at the final evaluation (P < .001). The ROM and MEPS results at every follow-up were comparable for both traumatic and degenerative contractures. ROM improved regardless of the severity of contracture. CONCLUSIONS Arthroscopic elbow arthrolysis was similarly efficient in ROM restoration in both traumatic and degenerative contractures and regardless of the severity of contracture. After early deterioration, the achieved gain slowly recovers over a period of 6 months but may not recover to the ranges achieved during arthroscopy.
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Affiliation(s)
- Przemysław Lubiatowski
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznań, Poznań, Poland; Upper Limb Unit, Rehasport Clinic, Poznań, Poland.
| | - Marta Ślęzak
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznań, Poznań, Poland; Upper Limb Unit, Rehasport Clinic, Poznań, Poland
| | - Joanna Wałecka
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznań, Poznań, Poland; Upper Limb Unit, Rehasport Clinic, Poznań, Poland
| | - Maciej Bręborowicz
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznań, Poznań, Poland; Upper Limb Unit, Rehasport Clinic, Poznań, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznań, Poznań, Poland
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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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26
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Hilgersom NFJ, Molenaars RJ, van den Bekerom MPJ, Eygendaal D, Doornberg JN. Review of Poehling et al (1989) on elbow arthroscopy: a new technique. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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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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28
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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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29
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Kim SJ, Kim JW, Lee SH, Choi JW. Retrospective Comparative Analysis of Elbow Arthroscopy Used to Treat Primary Osteoarthritis With and Without Release of the Posterior Band of the Medial Collateral Ligament. Arthroscopy 2017; 33:1506-1511. [PMID: 28454997 DOI: 10.1016/j.arthro.2017.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and functional outcomes of arthroscopic debridement arthroplasty with the release of the posterior band of the medial collateral ligament in patients with primary osteoarthritis. METHODS We evaluated 43 patients treated with arthroscopic debridement arthroplasty for elbow osteoarthritis from February 2006 to February 2014. In group A (n = 19), the posterior band of the medial collateral ligament was released, and in group B (n = 24), it was not released. The mean follow-up period in groups A and B was 55.4 months (range, 24-100 months) and 62.2 months (range, 24-103 months), respectively. Clinical results were evaluated by measuring the preoperative and postoperative range of motion (ROM) of the elbow, visual analog scale score, and Mayo Elbow Performance Score. RESULTS Both groups showed significant improvement in clinical outcome (visual analog scale and Mayo Elbow Performance Score) at the final follow-up compared with preoperative evaluation (group A, P = .009 and .013, respectively; group B, P = .015 and .008, respectively). Group A showed significant improvement in increased flexion at 6 months of follow-up (P = .043). However, there was no statistically significant difference in postoperative ROM and clinical results between the 2 groups at the final follow-up (P = .482). CONCLUSIONS Arthroscopic debridement arthroplasty with the release of the posterior band of the medial collateral ligament was associated with improved flexion at the 6-month postoperative follow-up, but no significant difference between the groups was observed at the final follow-up. Therefore, the additional release of the posterior band of the medial collateral ligament may be unnecessary for improving postoperative ROM. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Se Jin Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Jeong Woo Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea.
| | - Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Ji Woong Choi
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
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An Expedited Care Pathway with Ambulatory Brachial Plexus Analgesia Is a Cost-effective Alternative to Standard Inpatient Care after Complex Arthroscopic Elbow Surgery. Anesthesiology 2015; 123:1256-66. [DOI: 10.1097/aln.0000000000000852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background
Common standard practice after complex arthroscopic elbow surgery includes hospital admission for 72 h. The authors hypothesized that an expedited care pathway, with 24 h of hospital admission and ambulatory brachial plexus analgesia and continuous passive motion at home, results in equivalent elbow range of motion (ROM) 2 weeks after surgery compared with standard 72-h hospital admission.
Methods
A randomized, single-blinded study was conducted after obtaining approval from the research ethics board. Forty patients were randomized in a 1:1 ratio using a computer-generated list of random numbers into an expedited care pathway group (24-h admission) and a control group (72-h admission). They were treated equally aside from the predetermined hospital length of stay.
Results
Patients in the control (n = 19) and expedited care pathway (n = 19) groups achieved similar elbow ROM 2 weeks (119 ± 18 degrees and 121 ± 15 degrees, P = 0.627) and 3 months (130 ± 18 vs. 130 ± 11 degrees, P = 0.897) postoperatively. The mean difference in elbow ROM at 2 weeks was 2.6 degrees (95% CI, −8.3 to 13.5). There were no differences in analgesic outcomes, physical function scores, and patient satisfaction up to 3 months postoperatively. Total hospital cost of care was 15% lower in the expedited care pathway group.
Conclusion
The results suggest that an expedited care pathway with early hospital discharge followed by ambulatory brachial plexus analgesia and continuous passive motion at home is a cost-effective alternative to 72 h of hospital admission after complex arthroscopic elbow surgery.
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Merolla G, Buononato C, Chillemi C, Paladini P, Porcellini G. Arthroscopic joint debridement and capsular release in primary and post-traumatic elbow osteoarthritis: a retrospective blinded cohort study with minimum 24-month follow-up. Musculoskelet Surg 2015; 99 Suppl 1:S83-S90. [PMID: 25957550 DOI: 10.1007/s12306-015-0365-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/19/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Elbow osteoarthritis (OA) is a degenerative condition which in the advanced stage can severely impair joint mobility. Conservative treatment remains the first choice; surgery should be considered in case of failure in patients prepared to adhere to a demanding rehabilitation protocol. We assess the effectiveness of arthroscopic joint debridement and capsular release in a series of patients with primary and post-traumatic elbow arthritis. MATERIALS AND METHODS Forty-eight subjects (40 males, eight females; mean age 48 years) with a preoperative diagnosis of primary (19, 40 %) or post-traumatic OA (29, 60 %) were evaluated at a mean follow-up of 44 months. Outcome measures were active range of motion (ROM), pain score, Oxford elbow score (OES), and Mayo elbow performance score (MEPS). OA severity was graded into three classes (I-III) based on X-ray findings. Statistical significance was set at 5 %. RESULTS At the final follow-up evaluation, active flexion/extension increased significantly (p < 0.01); pronation and supination improved, but the difference was not significant (p > 0.05). The pain score improved from 7.2 to 4.3 (p < 0.01). Both OES and MEPS improved significantly (p < 0.001). Patients with post-traumatic OA had better ROM (p = 0.0391) and clinical scores (OES, p = 0.011; MEPS, p = 0.010). ROM and clinical scores were lower but not significantly so in class II than in class I patients. A smooth coronoid and olecranon fossa was found in 38 (79 %) patients and a preserved ulnotrochlear joint space in 40 (80 %). CONCLUSIONS Elbow OA has become more common as a result of earlier diagnosis and an increased number of acute injuries involving the joint. Arthroscopy is an effective technique to treat OA which provides the best results with the correct indications. Prospective studies are needed to help develop guidelines enabling selection of the best treatment option.
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Affiliation(s)
- G Merolla
- Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica - AUSL della Romagna Ambito Territoriale di Rimini, 47841, Cattolica, Italy.
- "Marco Simoncelli" Biomechanics Laboratory, "D. Cervesi" Hospital, Cattolica - AUSL della Romagna Ambito Territoriale di Rimini, Cattolica, Italy.
| | - C Buononato
- Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica - AUSL della Romagna Ambito Territoriale di Rimini, 47841, Cattolica, Italy
| | - C Chillemi
- Department of Orthopedics and Traumatology, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - P Paladini
- Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica - AUSL della Romagna Ambito Territoriale di Rimini, 47841, Cattolica, Italy
| | - G Porcellini
- Unit of Shoulder and Elbow Surgery, "D. Cervesi" Hospital, Cattolica - AUSL della Romagna Ambito Territoriale di Rimini, 47841, Cattolica, Italy
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