Chapter 27 Elbow Instability and Reconstruction

Osteoarthritis Osteoarthritis of the elbow joint can occur primarily or secondary to trauma. Primary osteoarthritis usually occurs in middle-aged men who often have performed manual labor. In the early stages, nonsurgical management with nonsteroidal anti-inflammatory drugs, activity modification, and corticosteroid injections can be helpful. Arthroscopic débridement and synovectomy, and débridement or interpositional arthroplasty are generally recommended for younger, active patients who do not respond to nonsurgical management. For older and more sedentary patients, total elbow arthroplasty is considered the procedure of choice. A 2008 study reported on arthroscopic osteophyte resection and capsulectomy in 41 patients with primary osteoarthritis.1 At follow-up of more than 2 years, the authors identified significant improvements in flexion and extension, supination, and functional scores. Many patients (81%) reported good to excellent results with a significant decrease in pain; complications were rare. In a study with seven patients, the outcomes of treating osteochondral lesions in the elbow with autologous osteochondral transplantation were reported.2 The grafts were harvested from the lateral femoral condyle. Significant improvements occurred in pain and functional scores. Graft viability was confirmed in all patients with postoperative MRI. A recent study reported on 11 patients younger than 50 years who were treated with arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow after failed nonsurgical treatment.3 An allarthroscopic technique was used. It was concluded that the procedure resulted in significant short-term pain relief, restoration of motion, and improved function. In a recent radiographic study of arthritic elbows using CT scanning, a higher incidence of ulnohumeral osteophytes (95%) was identified compared with radiocapitellar joint osteophytes (59%).4 The study authors challenged the notion that osteoarthritis originates in the radiohumeral joint.