Open vs. Arthroscopic Treatment of Elbow Arthritis
Abstract & Commentary
Synopsis: Although both arthroscopic and open debridement procedures were successful for patients with osteoarthritis, the arthroscopic group showed somewhat better pain relief and the open group showed somewhat better motion comparatively.
Source: Cohen AP, et al. Treatment of osteoarthritis of the elbow: A comparison of open and arthroscopic debridement. Arthroscopy 2000;16(7):701-706.
This study examines the efficacy of open debridement of elbow osteoarthritis (OA) (Outerbridge-Kashiwagi procedure) vs. arthroscopic debridement including fenestration of the olecranon fossa.1 Patients were allocated to treatment based on the hospital where they presented. The two study groups were similar: mostly middle aged males with primary OA. Preoperative radiographs showed typical osteophytes in the olecranon fossa and coronoid process. Loose bodies were visualized in 55% of cases. The majority of patients complained of pain, stiffness, and locking.
The open procedure was performed through a triceps splitting approach with olecranon osteophyte excision, loose body removal, olecranon fossa fenestration, and coronoid osteophyte excision. The arthroscopic procedure consisted of debridement, loose body removal, synovectomy if necessary, and fenestration of the olecranon process. No osteophyte excision was performed. The results were then compared using the Mayo Clinic Elbow Function Chart at a mean 35 months. Both groups showed a significant increase in range of motion, and an improvement in symptoms of pain and locking. There were no significant complications. Only one patient out of 44 required further surgery. Cohen and colleagues concluded both arthroscopic debridement with fenestration of the olecranon fossa and the open O-K procedure are effective in improving pain, flexion and extension, and result in satisfied patients.
Comment by Stephen B. Gunther, MD
To my knowledge, this is the first comparative study of arthroscopic vs. open debridement procedures for primary elbow arthritis. In this short-term study (mean follow-up, 35 months), the majority of patients were satisfied with their procedure. The results show moderate improvements in motion (average 8° increase in arthroscopic group and 19° improvement in open group) and excellent short-term improvement in pain. No soft tissue procedures (contracture release) were performed. Also, no radial head excisions were performed. This is an important addition to the literature since a defined group of patients with primary OA of the elbow were prospectively randomized by treatment center to arthroscopic vs. open procedures which both produced successful results.
Further research will be necessary to evaluate arthroscopic procedures in combined groups of patients such as post-traumatic arthritis with contractures. Also, arthroscopic techniques have been expanded significantly since this series was performed (1988-1993).2-4 For example, many surgeons now routinely perform osteophyte excision arthroscopically as well as radial head excision when necessary. Capsular release may also be performed arthroscopically by experienced surgeons. Future studies will be necessary to determine the efficacy and safety of these more aggressive surgical procedures as well as document the long-term results.
References
1. Kashiwagi D. Osteoarthritis of the elbow joint: Intra-articular changes and the special operative procedure; Outerbridge-Kashiwagi method (O-K method). In: Kashiwagi D, ed. The Elbow Joint. Proceedings of the International Congress, Japan. Amsterdam, The Netherlands: Elsevier, 1985: 177-188.
2. O’Driscoll SW. Arthroscopic treatment for osteoarthritis of the elbow. Orthop Clin North Am 1995;26:691-706.
3. Redden JF, Stanley D. Arthroscopic fenestration of the olecranon fossa in the treatment of osteoarthritis of the elbow. Arthroscopy 1993;9:14-16.
4. Savoie FH, et al. Arthroscopic management of the arthritic elbow: Indications, technique, and results. J Shoulder Elbow Surg 1999;8:214-219.
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