Arthroscopic debridement without radial head excision of the osteoarthritic elbow.

摘要

PURPOSE: This study evaluated the short-term clinical outcomes of patients with osteoarthritis of the elbow joint, including grade III or IV radiocapitellar arthritis, treated with debridement of the radial head in conjunction with arthroscopic ulnohumeral arthroplasty. METHODS: Between 1993 and 1999, in 24 patients (25 elbows) who underwent arthroscopic treatment for degenerative arthritis with impingement, arthroscopic findings revealed grade III or IV radiocapitellar arthritis. All were treated by debridement of the anterior and posterior osteophytes and capsular release alone, while the radial head was left intact. Average patient age was 51 years (range, 16 to 59). Average follow-up was 67 months (range, 24 to 123). Patients were evaluated preoperatively and postoperatively with the subjective/objective scoring system of Andrews and Carson. RESULTS: Of 25 elbows treated, 24 were "better" or "much better" after surgery; 1 patient's condition was unchanged. In all, 21 patients reported minimal or nopain in the elbow, and 4 reported mild to moderate persistent pain. The average flexion-extension arc improved by 21 degrees , and the number of patients with a flexion contracture greater than 5 degrees dropped from 22 to 3 post surgery. According to the elbow rating system of Andrews and Carson, 14 patients had an excellent result, 7 good, 3 fair, and 1 poor. Twelve patients reported no limitations in their daily activities, and 12 experienced occasional problems. No surgical complications were reported. Conclusions: Arthroscopic debridement of the arthritic elbow provides reasonable pain relief and improves motion even in the presence of moderate to severe radiocapitellar chondral loss. Resecting the arthritic radial head is not essential to obtaining an excellent functional outcome. LEVEL OF EVIDENCE: Level IV, therapeutic case series.