Between 1994 and 2002, 81 patients underwent ulnohumeral arthroplasty for elbow arthritis at our institution. All patients were sent a questionnaire with a request to attend for a clinical evaluation. Forty replied and 34 attended for clinical examination, 6 females and 34 males with an average age of 63 years (32-80) and a mean follow-up of 6 years (2-10). There were 22 (55%) patients with primary osteoarthritis, 14 (35%) with osteoarthritis secondary to trauma, two patients with rheumatoid arthritis and one patient each with arthrogryphosis multiplex congenital and post-septic arthritis of the elbow. Using the VAS (0-10), the pain score was seen to improve from a mean pre-operative score of 8 (6-10) to 4 (0-9). 21 patients (50%) were on minimal or no analgesia and 31 (75%) patients felt they would have the surgery again for the same problem. The arc of motion as regards flexion/extension was found to increase by 19% while prono-supination was found to increase by 30%. There was one patient each with superficial infection, anterior interosseous nerve neuropathy and myositic ossificans while two patients had triceps rupture. Radiological examination showed that in 12 cases the trephine hole was partially obliterated while in 4 cases it was completely obliterated. This could not be correlated clinically. Patients with loose bodies seemed to do better in the post-operative phase. Ulnohumeral arthroplasty has a role in the management of the arthritic elbow as it provides pain relief in the post-operative period; however, the improvement in the range of movement is limited particularly as regards the arc of extension

Open debridement and Outerbridge and Kashiwagi debridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis. However, the literature contains little information on the long-term survivorship of these procedures. The purpose of this study was to determine the survivorship after elbow debridement techniques until conversion to total elbow arthroplasty and revision surgery. We performed a retrospective chart review of patients who underwent open elbow surgical debridement (open debridement, OK procedure) between 2000 and 2015. Patients were diagnosed with primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients had primary surgery including open debridement (n=142) and OK procedure (n=178), and of these 33 patients required a secondary revision surgery (open debridement, n=14 and OK procedure, n=19). The average follow-up time was 11.5 years (5.5 - 21.5 years). Survivorship was analyzed with Kaplan-Meier curves and Log Rank test. A Cox proportional hazards model was used assess the likelihood of conversion to total elbow arthroplasty or revision surgery while adjusting for covariates (age, gender, diagnosis). Significance was set p<0.05. Kaplan-Meier survival curves showed open debridement was 100.00% at 1 year, 99.25% at 5 years, and 98.49% at 10 years and for OK procedure 100.00% at 1 year, 98.80% at 5 years, 97.97% at 10 years (p=0.87) for conversion to total elbow arthroplasty. There was no difference in survivorship between procedures after adjusting for significant covariates with the cox proportional hazard model. The rate of revision for open debridement and OK procedure was similar at 11.31% rand 11.48% after 10 years respectively. There were higher rates of revision surgery in patients with open debridement (hazard ratio, 4.84 CI 1.29 – 18.17, p = 0.019) compared to OK procedure after adjusting for covariates. We also performed a stratified analysis with radiographic severity as an effect modifier and showed grade 3 arthritis did better with the OK procedure compared to open debridement for survivorship until revision surgery (p=0.05). However, this difference was not found for grade 1 or grade 2 arthritis. This may suggest that performing the OK procedure for more severe grade 3 arthritis could decrease reoperation rates. Further investigations are needed to better understand the indications for each surgical technique. This study is the largest cohort of open debridement and OK procedure with long term follow-up. We showed that open elbow debridement and the OK procedure have excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post traumatic cases. The OK procedure also has lower rates of revision surgery than open debridement, especially with more severe radiographic arthritis

Open debridement and Outerbridge and Kashiwagi debridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis. However, the literature contains little information on the long-term survivorship of these procedures. The purpose of this study was to determine the survivorship after elbow debridement techniques until conversion to total elbow arthroplasty and revision surgery. We performed a retrospective chart review of patients who underwent open elbow surgical debridement (open debridement, OK procedure) between 2000 and 2015. Patients were diagnosed with primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients had primary surgery including open debridement (n=142) and OK procedure (n=178), and of these 33 patients required a secondary revision surgery (open debridement, n=14 and OK procedure, n=19). The average follow-up time was 11.5 years (5.5 - 21.5 years). Survivorship was analyzed with Kaplan-Meier curves and Log Rank test. A Cox proportional hazards model was used assess the likelihood of conversion to total elbow arthroplasty or revision surgery while adjusting for covariates (age, gender, diagnosis). Significance was set p<0.05. Kaplan-Meier survival curves showed open debridement was 100.00% at 1 year, 99.25% at 5 years, and 98.49% at 10 years and for OK procedure 100.00% at 1 year, 98.80% at 5 years, 97.97% at 10 years (p=0.87) for conversion to total elbow arthroplasty. There was no difference in survivorship between procedures after adjusting for significant covariates with the cox proportional hazard model. The rate of revision for open debridement and OK procedure was similar at 11.31% rand 11.48% after 10 years respectively. There were higher rates of revision surgery in patients with open debridement (hazard ratio, 4.84 CI 1.29 - 18.17, p = 0.019) compared to OK procedure after adjusting for covariates. We also performed a stratified analysis with radiographic severity as an effect modifier and showed grade 3 arthritis did better with the OK procedure compared to open debridement for survivorship until revision surgery (p=0.05). However, this difference was not found for grade 1 or grade 2 arthritis. This may suggest that performing the OK procedure for more severe grade 3 arthritis could decrease reoperation rates. Further investigations are needed to better understand the indications for each surgical technique. This study is the largest cohort of open debridement and OK procedure with long term follow-up. We showed that open elbow debridement and the OK procedure have excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post traumatic cases. The OK procedure also has lower rates of revision surgery than open debridement, especially with more severe radiographic arthritis

Background. The optimal treatment for symptomatic elbow osteoarthritis remains debatable especially in patients still involved in heavy manual work. The Outerbridge-Kashiwagi (OK) procedure has been used when simple measures fail. The aim of this study is to analyse the results of the OK procedure in patients with symptomatic osteoarthritis. Methods. Twenty-two patients were included in the study. The male:female ratio was 18:4. The mean age was 60 years with mean follow-up of 38 months (24–60 months). 17 were manual workers, 3 involved in sports activities and 2 non-manual workers. All patients were assessed using Mayo Elbow Performance Index Score system. Preoperative radiological assessment showed osteophytes around olecranon and coronoid process and joint space narrowing in radio-humeral articulationin all cases. Results. There was a significant improvement (p<0.05) in movement in the flexion-extension axis from 78.2° to 107.3°. There was a significant reduction in pain post-operatively (p<0.001). Mean MEPI score improved from 50 to 87.4 post surgery which was significant (p<0.05). One patient had ulnar nerve palsy which resolved in six months with conservative management. The results were excellent in six patients (27%), good in fifteen (68%), fair in one (5%) and one (5%) had poor result. Discussion and conclusion. The present study indicates that the OK procedure provides significant pain relief and a functionally useful range of movement of more than 100°. The procedure can be used in high demand patients, wherein total elbow replacement is not indicated. It significantly reduces the disability in patients with significant elbow arthritis

Purpose:. Interposition arthroplasty is a salvage procedure for patients with severe osteoarthritis of the elbow where conservative treatment failed. It is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. Although one of the oldest reconstructive options for elbow arthritis, the procedure is not without complications. There are only a few case series described in the literature. The purpose of our study is to review our cases and report their outcome. Method. We retrospectively reviewed 18 consecutive cases of interposition arthroplasty between 2001 and 2010. 2 cases were excluded due to incomplete records. The mean patient age was 41.3 (19.4–58.6) years at time of surgery. The primary diagnosis was post-traumatic osteoarthritis in 11 cases and inflammatory osteoarthritis in 5 cases. The mean follow up was 4.7 (0.4–10) years. Pre- and post-operative pain and function was evaluated using the Visual Analogue Scale (VAS) and Mayo Elbow Performance Score (MEPS). The complications and the number of re-operations and revisions were recorded. Summary of results:. In 12 (75%) cases at least one revision operation was performed, because of sepsis, ulnar nerve symptoms, instability and unsatisfactory clinical results. Sepsis rate was 25%. In 7 cases there was an unsatisfactory clinical result (i.e. ongoing pain and poor function), resulting in revision by total elbow replacement in 4 cases, arthrodesis in 2 cases and a re-do interposition in 1 case. The mean interval from the interposition to revision procedure was 2.6 (0.6–7.4) years. In 9 patients with the interposition currently in situ, mean VAS improved from 7.4 to 2.4 and mean MEPS from 42 (30–60) to 75 (40–100). Conclusion:. Interposition arthroplasty offered improvement in pain and function, but at a high cost. It is associated with a high rate of complications and need for revision surgery that we feel might be unacceptable