Treatment of osteoarthritis of the elbow: A comparison of open and arthroscopic debridement

Purpose: To assess the effectiveness of open and minimally invasive techniq ues in the debridement of osteoarthritis of the elbow, we compared the Oute rbridge-Kashiwagi (O-K) procedure with an arthroscopic modification in whic h arthroscopic debridement and fenestration of the olecranon fossa was perf ormed. Type of Study: The study took the form of a nonrandomized control tr ial in which subjects were allocated to a treatment depending on the hospit al of presentation. Materials and Methods: Assessment using the Mayo Clinic elbow function chart enabled comparison of the outcome in 18 cases treated by the O-K procedure and 26 patients treated by arthroscopic debridement a nd fenestration of the olecranon fossa. Mean follow-up was 35.3 months (min imum 12 months). Of the patients treated by the O-K procedure, 14 were men and 4 were women with a mean age of 55 years. In 83% of patients, the diagn osis was primary osteoarthritis, with the remainder post-traumatic arthriti s. The patients treated by arthroscopic debridement and fenestration of the olecranon fossa included 24 men and 2 women with a mean age of 46 years, a nd a diagnosis of primary osteoarthritis in 91% and post-traumatic arthriti s in the remainder. No patients were excluded from the study or refused to be included. Results: Both procedures were shown to be effective, with no m ajor complications. Patients treated by arthroscopic debridement and fenest ration of the olecranon fossa achieved better relief of pain (P <.10), wher eas those patients undergoing the O-K procedure achieved significantly grea ter improvement in range of flexion (P <.05). No difference between the pro cedures in terms of patient-perceived overall effectiveness of the surgery was found. Conclusions: In conclusion, in the treatment of osteoarthritis o f the elbow, arthroscopic debridement and fenestration of the olecranon fos sa may be a more suitable procedure when painful symptoms predominate. In c ontrast, the O-K procedure is a significantly better procedure for improvin g the range of flexion where this is a particular problem.