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Surgical Techniques   |    
Débridement Arthroplasty for Primary Osteoarthritis of the Elbow
Takuro Wada, MD1; Satoshi Isogai, MD1; Seiichi Ishii, MD1; Toshihiko Yamashita, MD1
1 Department of Orthopaedic Surgery, Sapporo Medical University, South 1, West 16, Sapporo 060-8543, Japan. E-mail address for T. Wada: twada@sapmed.ac.jp
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
The line drawings in this article are the work of Jennifer Fairman (jfairman@fairmanstudios.com).
Investigation performed at the Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 86-A, pp. 233-241, February 2004

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Mar 01;87(1 suppl 1):95-105. doi: 10.2106/JBJS.D.02684
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Abstract

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 Ortho-paedic 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.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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