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.
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.
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.
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.