Arthroscopic treatment of the arthritic elbow due to primary radiocapitellar arthritis

Abstract

Purpose: To retrospectively compare patients who received radial head excision for early, isolated radiocapitellar arthritis with those who had delayed surgery for the same problem in order to analyze risk factors for progression of the arthritis. Isolation of risk factors for progression should allow guidelines for early excision and perhaps prevent progression to panarticular arthritis.

Type of study: Retrospective analysis of a group of patients with radiocapitellar arthritis.

Methods: From 1995 to 2001, 36 consecutive patients with arthritic damage to the radiocapitellar joint were treated with arthroscopic debridement and radial head excision. Twenty-eight of the 36 underwent concurrent arthroscopic modification of the Outerbridge-Kashiwagi procedure because of the additional presence of ulnohumeral arthritis. All patients were re-examined 18 to 91 months (mean, 52 months) after the procedure and evaluated using the Andrews-Carson (A-C) elbow rating system.

Results: In patients who underwent radial head excision alone, flexion increased 29 degrees, extension 38 degrees, with an increase in total arc of motion of 62 degrees. In patients who underwent radial head excision and ulnohumeral arthroplasty, postoperative flexion increased 19 degrees, extension 27 degrees, with an increase in total arc of motion of 46 degrees. The difference between the 2 groups of patients was significant (P = .002). The average preoperative A-C score for patients undergoing radial head excision alone was 72 and the average postoperative score was 170. The average preoperative score for patients undergoing radial head excision and ulnohumeral arthroplasty was 92 and the average postoperative score was 150. Two patients who underwent the combined procedure had to return to surgery: 1 for a contracture release and 1 for radial head replacement secondary to intractable pain. They both did well subsequently.

Conclusions: Patients undergoing radial head excision alone increased their average A-C score almost 100 points. Those undergoing both procedures increased their score an average of 58 points. In addition, those undergoing only radial head excision had a 20-point higher average overall postoperative A-C rating than those undergoing both procedures. Patients who underwent radial head excision alone had a greater return of range of motion and fewer postoperative complications than those who underwent the combined procedure.

Level of evidence: Level IV.