Midterm outcomes and survivorship of arthroscopic elbow debridement: a comparison of posttraumatic versus primary degenerative osteoarthritis

Abstract

Background Arthroscopic debridement is an effective means of surgical management of both degenerative osteoarthritis (DOA) and posttraumatic arthritis (PTA) of the elbow. However, the difference in the efficacy and longevity of this procedure when performed for these two distinct pathologies remains in question. The purpose of this study was to identify and compare the midterm outcomes and survivorship of arthroscopic debridement of elbow PTA and DOA. Methods A retrospective analysis of patients undergoing arthroscopic debridement of DOA and PTA of the elbow was performed. A questionnaire containing the Oxford Elbow Score, as well as questions regarding the incidence of reoperation, additional nonoperative intervention, complications, pain, and satisfaction, was given at 5 years, minimum, after surgery. The midterm survivorship of arthroscopic debridement free of reoperation for any reason, as well as the remaining outcome measurements obtained via the questionnaire and in-office evaluation, was compared between PTA and DOA cohorts. Results Eighty patients (DOA = 36, PTA = 44) were included in this study for analysis. All 36 patients with DOA were noted to be male. Follow-up time at the date of questionnaire response was 7.9 years (range, 5.6-11.8) in the DOA cohort and 8.6 years (range, 5.7-12.7) in the PTA cohort. Reoperation rates of 5.6% and 11.4% were identified in the DOA and PTA cohorts, respectively. No statistical difference was noted in reoperation rate, survivorship, or any measured patient-reported outcomes between cohorts at the final follow-up visit. Both cohorts demonstrated a significant improvement in Visual Analog Scale pain scores ( P < .001) and ROM. Postoperative ROM was obtained at the final clinic visit at an average follow-up duration of 151 days and 255 days in the DOA and PTA cohorts, respectively. However, no difference in the degree of improvement in either outcome variable was identified after a comparison between cohorts. Conclusion Arthroscopic debridement is an equally efficacious treatment option for DOA and PTA of the elbow. Patients with either pathology can expect satisfactory elbow function and an improvement in pain with little chance of reoperation at the midterm of the follow-up duration.

Clinical Outcomes of Revision Arthroscopic Osteocapsular Arthroplasty in Primary Elbow Osteoarthritis: A Retrospective Cohort Study

“…We were unable to locate any previous studies reporting the analysis of clinical outcomes in revision surgery, although there have been several reports of clinical outcomes after primary arthroscopic OCA. For example, DeBernardis et al 8 ) were comparable or superior and all patients were very satisfied or satisfied, which is consistent with the purpose of revision surgery. Revision OCA could be actively considered in patients with primary elbow OA who underwent primary OCA with persistent symptoms after nonoperative treatment.…”

“…We were unable to locate any previous studies reporting the analysis of clinical outcomes in revision surgery, although there have been several reports of clinical outcomes after primary arthroscopic OCA. For example, DeBernardis et al 8 noted improvements in ROM arc (91.9° to 115.4°) and VAS pain score (6.1 to 1.7) in 36 patients, while Adams et al 1 cited improvements in ROM arc (97.0°± 24.8° to 123.2°± 17.2°) and MEPS (67.5 ± 12.9 to 84.4 ± 16.1) in 42 elbows. Lim et al 22 further revealed improvements in ROM arc (84° to 104°), VAS pain score (4.5 to 2.2), and MEPS (57.4 to 81.3) in 43 elbows.…”

“…The American Journal of Sports Medicine 2023;51 (8):2050-2056 DOI: 10.1177/03635465231171542 Ó 2023 The Author(s) the progression of OA after primary arthroscopic OCA. Several previous studies reported that revision surgery is needed in some cases after arthroscopic OCA; yet, to the best of our knowledge, detailed analysis and assessment of clinical outcomes after revision surgery have not yet been studied.…”

“…Several previous studies reported that revision surgery is needed in some cases after arthroscopic OCA; yet, to the best of our knowledge, detailed analysis and assessment of clinical outcomes after revision surgery have not yet been studied. 8,15,22 Therefore, this study aimed to assess clinical outcomes after revision arthroscopic OCA and to compare clinical outcomes between primary and revision surgery for primary elbow OA. Subgroup analysis between radiologically severe cases of OA in each group was performed to adjust for radiologic severity, which is a known confounding factor for clinical outcomes.…”

Serial Changes in Clinical Outcomes After Arthroscopic Osteocapsular Arthroplasty for Primary Elbow Osteoarthritis: A Medium-term Follow-up Study

“…Rettig et al 24 reported a mean ROM gain of 30° in 17 patients with a mean follow-up of 65 months, albeit without statistical analysis. DeBernardis et al 7 noted improvements in extension (from 118.1° to 126.7°), flexion (from 26.2° to 11.3°), and VAS pain (from 6.1 to 1.7) in 36 patients with a mean follow-up of 7.9 years, albeit without statistical analysis of the primary elbow OA group. Kim et al 13 found significant improvements in extension (from 17.5° to 11.2°; P < .05), flexion (from 101.5° to 115.3°; P < .05), VAS pain (from 4.2 to 0.8; P = .009), and MEPS (from 55.8 to 89.5; P = .013) in 43 patients with primary elbow OA.…”