Capsulectomy and debridement for primary osteoarthritis of the elbow through a medial trans-flexor approach.

PURPOSE: Debridement arthroplasty combined with capsulectomy for primary osteoarthritis of the elbow is a useful procedure to relieve pain and increase mobility. We have used a medial trans-flexor approach without tendon detachment for debridement arthroplasty of the elbow and evaluated the outcome of this procedure.

METHODS

Thirty-one elbows with primary osteoarthritis in 31 patients treated with debridement arthroplasty were available for follow-up at a mean of 19 ± 7 months. Twenty-four patients were men, and 7 were women. The mean age at the time of surgery was 59 ± 10 years. All elbows were painful only at the end points of motion. The anterior compartment of the elbow was accessed by splitting of the pronator flexor muscle group without tendon detachment. Routine anterior subcutaneous transposition of the ulnar nerve was used in all elbows. In 10 elbows, osteophytes or loose osseous bodies from the lateral compartment were removed through an additional lateral approach.

RESULTS

Twenty-three elbows had no pain, and 8 elbows had mild pain. The mean preoperative limitation of extension decreased from 29° ± 9° to 15° ± 9° and the mean preoperative flexion increased from 100° ± 10° to 126° ± 7°. Thus, the mean arc of elbow motion increased by 40° ± 13°. The mean Mayo Elbow Performance Score was 94 ± 7 compared with 60 ± 5 before surgery. The results were excellent for 22 elbows and good for 9. Hematomas developed in 3 elbows, but they did not require surgical drainage.

CONCLUSIONS

Debridement arthroplasty using the medial trans-flexor approach without tendon detachment yields satisfactory short-term clinical results. This approach is associated with a low rate of complications and is safe and effective for the treatment of primary osteoarthritis of the elbow.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.