Treatment of osteoarthritis of the elbow with open or arthroscopic debridement: a narrative review

Abstract

BackgroundElbow osteoarthritis (OA) is a common disabling condition because of pain and loss of motion. Open and arthroscopic debridement are the preferred treatment, however there is no consensus on which treatment modality is suited to which category of patient or stage of disease. The objective of this study was to narratively review the literature for a more comprehensive understanding of its treatment options and associated outcomes, trying to provide a better treatment plan.MethodsThe PubMed database, EMBASE, Cochrane Library, and Google Scholar were searched, using the keywords (elbow [title/abstract] and osteoarthritis [title/abstract] and (surgery or open or arthroscop* or debridement or ulnohumeral arthroplasty) including all possible studies with a set of inclusion and exclusion criteria.ResultsA total of 229 studies were identified. Twenty-one articles published between 1994 and 2016 satisfied the inclusion and exclusion criteria including 651 elbows in 639 patients. After comparison, mean postoperative improvement in (ROM) was 28.6° and 23.3°,Mayo elbow performance score/index(MEPS/MEPI) 31 and 26.8 and the total complication rate was 37(11.5%), and 18(5.5%) for open and arthroscopic procedure.ConclusionsThis narrative review could not provide an insight on which surgical procedure is superior to the other due to the poor orthopedics literature. However, from the data we obtained the open and arthroscopic debridement procedures seem to be safe and effective in the treatment of elbow OA. The optimal surgical intervention for the treatment of symptomatic elbow OA should be determined depending on patients’ conditions.

Arthroscopic and open debridement in primary elbow osteoarthritis: a systematic review and meta-analysis

“…Open debridement requires a larger incision, with more soft tissue injury with a possible risk of soft tissue contraction and a higher risk of infection and haematoma. 51 This could be the reason why in the current review there are double the number of complications in the open group compared to the arthroscopic group. Especially more neurologic complications and haematomas occurred in the open group, possibly due to this larger incision.…”

“… 63 , 64 A review by Poonit et al stated that patients undergoing open surgery have a higher rate of postoperative infections compared with those undergoing arthroscopic debridement. 51 This review shows a 1% risk of infection for both arthroscopic and open debridement. The low rate of (infectious) complications from Poonit et al in arthroscopic debridement could be explained by the smaller size of the incision and thus, a lower risk of soft tissue injury.…”

“…Other reviews have been written about the comparison of arthroscopic and open debridement. A narrative review by Poonit et al 51 described 21 articles about arthroscopic and open debridement on elbow OA. Due to the use of a meta-analysis, this systematic review will provide a more elaborated comparison between the arthroscopic and open groups.…”

Open-label phase 3 study of diclofenac conjugated to hyaluronate (diclofenac etalhyaluronate: ONO-5704/SI-613) for treatment of osteoarthritis: 1-year follow-up

“…A typical medical treatment is pain management with analgesics such as NSAIDs. However, IA injection, which is widely used for knee OA patients, is not a common treatment option for other joints, and data of its efficacy are limited [ 27 – 32 ]. One of the aims of this study was to use DF-HA for various OA; therefore, patients with knee, shoulder, elbow, hip, and ankle OA were enrolled to evaluate the safety and efficacy of DF-HA.…”

Arthroscopic Management of Elbow Osteoarthritis

“…The possible treatments for this condition are open surgery and arthroscopic debridement, even if the gold standard procedure is still uncertain. Poonit et al [21] published a narrative review on this topic; however they were not been able to establish the most suitable operative technique due to the paucity of studies in literature. Arthroscopy provides excellent pain relief and mobility recovery in selected cases.…”