Arthroscopic osteocapsular arthroplasty yielded good outcomes, survivorship
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Arthroscopic osteocapsular arthroplasty for elbow contracture led to an increase in motion, good to excellent outcomes and good long-term survivorship, according to results from the American Shoulder and Elbow Surgeons Annual Meeting.
Jorge Rojas-Lievano, MD, and colleagues evaluated outcomes of 198 patients who underwent arthroscopic osteocapsular arthroplasty for elbow contracture due to either osteoarthritis or trauma. Researchers compared outcomes between diagnoses and whether the procedure was primary or a revision of a previous failed release.
“Seventy-nine patients had short-term data only, 39 patients had long-term data only and 80 patients had data for both set of points,” Rojas-Lievano said in his presentation. “The short-term follow-up was at a mean of 15 months, whereas the long-term follow-up was at a mean of 14 years.”
Rojas-Lievano noted a significant increase in total arc of motion from 80° preoperatively to 115° in the short-term follow-up. He added total arc of motion had a small but statistically significant decrease to 107° in the long-term. Patients with post-traumatic elbow contracture had significantly lower motion vs. patients with elbow contracture due to OA at baseline; however, patients in the post-traumatic and OA groups had no significant difference in motion at short-term follow-up, “indicating a higher recovery of motion in the post-traumatic cases than in the OA cases,” according to Rojas-Lievano.
“At long term, although both groups had a deterioration of motion compared with the short term, this deterioration was less in the post-traumatic cases than in the OA cases,” Rojas-Lievano said.
In the short term, Rojas-Lievano noted improvement in total arc of motion in primary cases vs. revision cases, a difference that increased in the long-term follow-up due to a 10° loss of motion over time in revision cases.
“In terms of [the] patient subjective evaluation we did through [subjective outcome determination] SOD score, at the short term, 92% of the patients were improved and 76% of the patients reported to be greatly improved for better compared to before surgery,” Rojas-Lievano said.
He noted these results did not change at long-term follow-up, with no differences in the subjective outcome determination score at any point between the OA and post-traumatic groups or the primary and revision groups.
Perspective
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Arthroscopic osteocapsular arthroplasty of the elbow is described as removing bone spurs and loose bodies and releasing the capsule in order to restore motion and function and relieve pain. It is sometimes artfully described as “reshaping bones.” This study compares two cohorts who were treated for contracture due to either trauma or OA. Both groups showed moderate short-term and modest long-term improvement in motion. Post-traumatic patients retained more motion improvement than OA patients. Most importantly, the majority of patients in both groups noted subjective improvement.
The relative popularity of this procedure exists in part due to the low functional demand and capabilities of prosthetic arthroplasty patients. At best, it provides clinical benefit without burning any bridges for future treatment. The benefits are clearer in patients with post-traumatic contracture. Potential caveats to this procedure include excessive bone resection leading to instability, and iatrogenic nerve injury. It remains a reasonable intermediate treatment option but also underlines the need for a more durable higher-demand prosthetic arthroplasty for OA.
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Rotman D, et al. Arthroscopic osteocapsular arthroplasty for elbow contracture — Long-term results. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 2-3, 2020 (virtual meeting).
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