This retrospective clinical review evaluates the long-term outcome of ulnohumeral arthroplasty for primary degenerative arthritis of the elbow. Forty-six elbows in 45 patients with primary osteoarthritis were reviewed at an average of 80 months (range, 24-164 months) after the operation. Pain at the extremes of motion were the chief complaint. There were 44 men and 1 woman with a mean age of 48 years (range, 30-74 years). Partial incision of the anterior capsule was performed in 13 patients and a column procedure was performed in 6 elbows. The mean Mayo Elbow Performance Score increased from 55 points to 83 points at final follow-up. Twenty-six patients had excellent results, 8 good, 4 fair, and 8 poor with overall a 74% satisfactory result. Three quarters of the patients had little or no pain at final follow-up. The overall gain in flexion-extension arc was 22 degrees with 87% showing an improvement. Only 57% had a functional extension-flexion arc at final follow-up. The mean gain in motion in elbows that underwent a column procedure was 29 degrees (range, -5 degrees to 50 degrees) compared with 17 degrees (range, 0-50 degrees) in elbows that did not undergo capsular release. The mean gain in pronation-supination was 2.6 degrees (range, -65 ? 75 degrees). One patient developed a complete ulnar nerve palsy that had undergone a submuscular transposition and a second developed a complete radial nerve palsy following discharge from the hospital. Thirteen of 45 patients complained of some degree of ulnar neuritis. Seven of these patients had symptoms preoperatively. Six patients underwent a delayed ulnar nerve decompression and transposition where as the patient with an ulnar nerve palsy underwent revision to a subcutaneous transposition. Two patients underwent elbow manipulation under anesthesia within the first 8 weeks after an ulnohumeral arthroplasty. One patient had a revision of the ulnohumeral arthroplasty without any improvement. One patient underwent arthroscopic debridement with removal of loose bodies 7 years after the index procedure. Fifty-nine percent showed recurrence of coronoid and olecranon osteophytes but to a lesser degree. Fourteen percent showed an increase in ulnohumeral joint narrowing and 26% had an increase in involvement of their radiohumeral joint.
This article examines the usefulness of ulnohumeral arthroplasty for primary degenerative arthritis of the elbow. It does, however, demonstrate many of the shortcomings of procedures performed for arthritis about the elbow. That is, joint space narrowing will progress and recurrence of osteophytes is quite common. In addition, improvement in the arc of motion may not be dramatic at long-term follow-up: the authors recommend a formal column procedure if the patient has a primary complaint of limited range of motion. In addition, particular attention is given to the ulnar nerve and it is recommended that all patients with preoperative ulnar nerve symptoms should undergo decompression of the ulnar nerve. In addition, although unsubstantiated by the data, they recommend ulnar nerve decompression or mobilization when preoperative flexion is less than 100 degrees due to the potential for stretch and nerve dysfunction after elbow release. Clearly strict attention to the ulnar nerve during any procedure about the elbow is necessary, and this is especially the case when surgically treating stiffness and arthritis.
J Bone and Joint Surg