Long-term results of open extensive débridement arthroplasty for primary osteoarthritis of the elbow: what direct examination and computed tomography images revealed

Abstract

Background

Although open and arthroscopic débridement arthroplasties are major surgical strategies in patients with primary osteoarthritis of the elbow, the long-term results remain inadequately studied. Therefore, this study aimed to evaluate long-term clinical and radiographic results after extensive débridement arthroplasty (EDA) for primary osteoarthritis of the elbow.

Methods

Eleven patients with primary osteoarthritis treated with EDA were able to be retrospectively evaluated by direct examination. The mean age of the seven male and four female patients was 56 years (range, 47-74 years). The surgical procedure involved the removal of all osteophytes and free bodies, release of anterior and posterior capsules, fenestration of the olecranon fossa, and excision of the posterior bundle of the ulnar collateral ligament. At a mean follow-up of 15 years, clinical and radiographic outcomes were assessed.

Results

The mean flexion increased significantly from 110.5° to 129.6° postoperatively in the short term and was generally maintained at the final follow-up. Conversely, the mean extension improved significantly from −26.4° to −11.4° postoperatively in the short term; however, at the final examination, it had decreased to −25.5°. According to the Mayo Elbow Performance score, results were excellent for five elbows, good for five, and fair for one. In all cases, postoperative pain was “none” or “mild,” and no postoperative complications were observed. In all cases, recurrence of osteophytes was seen, and the fenestration hole of the olecranon fossa remained open in three elbows, was partially refilled in four elbows and was completely refilled in four elbows at the time of the final follow-up. Univariate analysis revealed that among preoperative variables, age, arc of motion, and extension were prognostic factors that significantly affected postoperative extension in the long term.

Conclusions

The present findings indicate that EDA provides marked long-term relief of pain and improved flexion despite the recurrence of restricted extension. Patients with extremely restricted extension preoperatively are at the risk of deteriorated extension over the long term.