Background: Formal and more aggressive débridement procedures
have been described for the treatment of advanced primary osteoarthritis of
the elbow. However, the literature contains little information on the results
of long-term follow-up. The purpose of this study was to evaluate outcomes at
an average of ten years after débridement arthroplasties performed
through a posteromedial approach.
Methods: Thirty-three elbows with primary osteoarthritis in
thirty-two patients treated with débridement arthroplasty were
available for clinical follow-up evaluation. Through a posteromedial approach,
the flexor-pronator muscle origin was reflected from the medial epicondyle and
the joint was opened, preserving the anterior oblique bundle of the medial
collateral ligament. The ulnar nerve was decompressed in all patients.
Osteophytes were removed from the anterior, medial, and posterior sides of the
elbow joint. In nine elbows, osteophytes from the lateral compartment were
removed through an additional lateral approach. The mean age at the time of
the operation was fifty years. The mean duration of follow-up was 121 months,
and nineteen elbows were followed for more than ten years.
Results: The mean preoperative limitation of extension of 31°
was reduced to 24°, and the mean preoperative flexion of 101° improved
to 118° (p < 0.001). The mean arc of movement improved by 24°. The
mean Japanese Orthopaedic Association elbow score was 83 points at the latest
follow-up evaluation compared with 60 points preoperatively (p < 0.001). Of
twenty-five patients who had performed heavy manual work, nineteen (76%)
returned to their previous job or an equivalent job. At the latest examination
of the nineteen elbows followed for more than ten years, the limitation of
extension was found to have increased by 7° compared with the limitation
noted at one year (p < 0.009); the mean arc of flexion had remained the
same. Three elbows required a reoperation. Overall, 85% of the elbows were
satisfactory to the patients.
Conclusions: Débridement arthroplasty through a posteromedial
approach can provide stable and reliable long-term results with regard to
relief of pain, gains in range of motion, and the patient's ability to return
to his or her previous occupation. In our series, a modest loss of extension
was observed at ten years, whereas the arc of flexion remained consistent.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.