This is a retrospective evaluation of 25 elbows in 24 patients who underwent arthroscopic treatment for degenerative arthritis of the elbow. Entry criteria were Grade III or IV radiocapitellar arthritis and degenerative changes of the humeroulnar joint. All patients underwent debridement of the anterior and posterior impinging osteophytes with capsular release alone. The radial head was left intact. The average age of the patients was 51 years. The average follow-up was 67 months, with a range of 24-123 months.
The results at average of 67 months demonstrated that 24 of 25 were better or much better after surgery, according to the Andrews and Carson scoring system. Twenty-one of 25 reported minimal or no pain in the elbow, 4 reported mild to moderate persistent pain. Range of motion improved by an average of 21 degrees. Twenty-two patients had flexion contractures pre-operatively, and only 3 had recurrence of the flexion contracture post-operatively. The authors experienced no complications.
The authors conclude that at an average of 5 year follow-up, arthroscopic debridement provides pain relief and improved arc of motion even in the presence of moderate to severe radiocapitellar joint changes. They conclude that resection of the radial head was not necessary in order to achieve a good functional outcome.
This article supports maintaining the radial head when treating elbow osteoarthritis surgically, despite changes that may be present at the radiocapitellar articulation. It is becoming increasingly clear that the radiocapitellar joint may be the “wear-generator” in osteoarthritis, leading to recurrent bouts of inflammation, pain, synovitis, loose bodies, osteophytes, etc. However, resection of the arthritic radial head may not be necessary in order to achieve a good or excellent outcome. It is of note that the authors performed radial head debridement. Whether debridement in the situation of Grade III or IV radiocapitellar joint arthritis is actually a partial radial head resection may be of debate.
The second significant factor is that, contrary to previous authors who reported disparate results for debridement of degenerative elbows, these authors reported good and excellent results in 21 of 25 elbows at an average of 5 years. These results are significantly better than previous authors who have acknowledged the propensity for the degenerative changes to recur. Perhaps the maintenance of the radiocapitellar buttress prevents recurrence of degenerative changes to a significant degree.
Elbow, Arthritis, Arthroscopy, Debridement, Radial, Head