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Clinical Outcome of Osteocapsular Arthroplasty for Primary Osteoarthritis of the Elbow: Comparison of Arthroscopic and Open Procedure.
Arthroscopy 2019 April
PURPOSE: To compare clinical and radiologic outcomes following open (OPEN) and arthroscopic (ARTHRO) osteocapsular arthroplasty for primary elbow osteoarthritis.
METHODS: Patients treated with osteocapsular arthroplasty between January 2010 and December 2015 were divided into OPEN and ARTHRO groups. OPEN was performed from January 2010 to October 2012, and ARTHRO from November 2012 to December 2015. OPEN and ARTHRO were performed in 35 and 52 elbows, respectively. Clinical outcome was measured using range of motion (ROM) arc, functional score (Mayo Elbow Performance Score [MEPS]), and pain score (visual analog scale [VAS]). Conventional radiography was used for outcome analysis. Outcomes were analyzed according to ulnohumeral joint (UHJ) narrowing using the computed tomography-based modified Broberg and Morrey classification.
RESULTS: Mean follow-up time was 36.6 ± 14.4 (24-89) and 35.4 ± 14.2 (24-83) months following OPEN and ARTHRO, respectively. Average ages were 50.0 ± 7.0 (40-63) and 52.4+10.4 (41-75) years in OPEN and ARTHRO groups, respectively. Overall scores for ROM (preoperative to final follow-up: 65.5° ± 22.8 to 112.0° ± 50.9, P < .01), MEPS (42.9 ± 13.7 to 73.7 ± 16.6, P < .01), and VAS (6.6 ± 1.3 to 4.0 ± 2.3, P < .01) were improved. Preoperative ROM improved from 64.0° ± 23.3 to 118.0° ± 17.8 following OPEN and 66.5° ± 22.6 to 108.0° ± 24.0 following ARTHRO. Preoperative MEPS improved from 40.7 ± 15.6 to 73.6 ± 16.7 following OPEN and 44.3 ± 12.2 to 73.8 ± 16.7 following ARTHRO. Preoperative VAS improved from 6.9 ± 1.2 to 3.9 ± 2.6 following OPEN and 6.4 ± 1.3 to 4.1 ± 2.0 following arthro. In both groups, the last follow-up VAS score and MEPS were worse in the narrowing group (UHJ <2 mm, grades 2 and 3) than in the intact group (UHJ >2 mm, grade 1) (P < .01).
CONCLUSIONS: Arthroscopic osteocapsular arthroplasty is comparable to the OPEN procedure in managing primary osteoarthritis of the elbow; however, the OPEN procedure shows the better outcome in improvement of flexion limitation. Neither procedures can guarantee an excellent outcome in the patients with severe UHJ narrowing.
LEVEL OF EVIDENCE: Level III, retrospective comparative trial.
METHODS: Patients treated with osteocapsular arthroplasty between January 2010 and December 2015 were divided into OPEN and ARTHRO groups. OPEN was performed from January 2010 to October 2012, and ARTHRO from November 2012 to December 2015. OPEN and ARTHRO were performed in 35 and 52 elbows, respectively. Clinical outcome was measured using range of motion (ROM) arc, functional score (Mayo Elbow Performance Score [MEPS]), and pain score (visual analog scale [VAS]). Conventional radiography was used for outcome analysis. Outcomes were analyzed according to ulnohumeral joint (UHJ) narrowing using the computed tomography-based modified Broberg and Morrey classification.
RESULTS: Mean follow-up time was 36.6 ± 14.4 (24-89) and 35.4 ± 14.2 (24-83) months following OPEN and ARTHRO, respectively. Average ages were 50.0 ± 7.0 (40-63) and 52.4+10.4 (41-75) years in OPEN and ARTHRO groups, respectively. Overall scores for ROM (preoperative to final follow-up: 65.5° ± 22.8 to 112.0° ± 50.9, P < .01), MEPS (42.9 ± 13.7 to 73.7 ± 16.6, P < .01), and VAS (6.6 ± 1.3 to 4.0 ± 2.3, P < .01) were improved. Preoperative ROM improved from 64.0° ± 23.3 to 118.0° ± 17.8 following OPEN and 66.5° ± 22.6 to 108.0° ± 24.0 following ARTHRO. Preoperative MEPS improved from 40.7 ± 15.6 to 73.6 ± 16.7 following OPEN and 44.3 ± 12.2 to 73.8 ± 16.7 following ARTHRO. Preoperative VAS improved from 6.9 ± 1.2 to 3.9 ± 2.6 following OPEN and 6.4 ± 1.3 to 4.1 ± 2.0 following arthro. In both groups, the last follow-up VAS score and MEPS were worse in the narrowing group (UHJ <2 mm, grades 2 and 3) than in the intact group (UHJ >2 mm, grade 1) (P < .01).
CONCLUSIONS: Arthroscopic osteocapsular arthroplasty is comparable to the OPEN procedure in managing primary osteoarthritis of the elbow; however, the OPEN procedure shows the better outcome in improvement of flexion limitation. Neither procedures can guarantee an excellent outcome in the patients with severe UHJ narrowing.
LEVEL OF EVIDENCE: Level III, retrospective comparative trial.
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