Radial head excision unnecessary in arthroscopic ulnohumeral arthroplasty for elbow osteoarthritis

Overall, 13 of 24 patients reported no limitations in daily activities and 11 reported only occasional problems after arthroscopic debridement without radial head excision.

Radial head resection may not be required to achieve satisfactory outcomes when performing arthroscopic ulnohumeral arthroplasty in patients with elbow osteoarthritis, a study suggests. In addition, preserving the radial head may slow arthritic progression, the study authors said.

"Despite the fact that a degenerative radial head was left intact, most patients in this series showed improvement in pain and motion after undergoing arthroscopic debridement, synovectomy, osteophyte removal, and capsular release as necessary," they wrote.

Edward W. Kelly, MD, and colleagues at centers in the United States and Australia, evaluated their results performing the surgery in 25 elbows of 24 patients treated at a mean age of 51 years. All cases showed degenerative arthritis with impingement and arthroscopic evidence of grade 3 or grade 4 radiocapitellar arthritis.

All patients had completed nonoperative treatment over an average of 56 months preoperatively. In all cases, surgeons arthroscopically debrided any inflamed and impinging soft tissues, removed anterior and posterior osteophytes and performed capsular release, according to the study, published in the journal Arthroscopy.

Surgeons left the radial head intact in all cases, the authors noted.

At 67 months mean follow-up, Visual Analog Scale-measured pain levels decreased to 2/10 from 7/10 preoperatively, with 21 patients reporting minimal or no pain, according to the study.

Using the Andrews and Carson elbow rating system, no patients had excellent scores preoperatively, one elbow was scored as good, 10 were fair and 14 were poor. After surgery, results were excellent in 14 patients, good in seven, fair in three and poor in only one, according to the study.

The subjective component of the Andrews and Carson system improved an average of 37 points after surgery, and the objective component improved an average of 24 points, the authors noted.

The researchers found that flexion contracture decreased from an average of 20° preoperatively to 9° at follow-up. Flexion-extension arc also improved, from an average of 111° preoperatively to 132° at follow-up, with only one patient failing to achieve a functional arc of motion, according to the study.

Overall, 13 patients reported no limitations in performing daily activities and 11 reported only occasional problems. Also, 13 of the 24 patients could return to their presurgery work activities, the authors reported.

No patients experienced any surgical complications and none required further operation, they noted.

"Other authors have ... noted progression of ulnohumeral arthritis after radial head excision," the authors said. "We attempted to avoid this problem by not excising the radial head despite moderate to severe degenerative changes in the radiocapitellar joint.

"We believe that preserving the radial head may slow the progression of ulnohumeral articular surface damage, while not compromising functional outcomes of the procedure," they wrote, adding that longer follow-up is necessary to confirm their hypothesis.

For more information:
Kelly EW, Bryce R, Coghlan J, Bell S. Arthroscopic debridement without radial head excision of the osteoarthritic elbow. Arthroscopy. 2007;23:151-156.