Arthroscopic management of arthritic elbow

1. Arthroscopic Treatment of
the Arthritic Elbow
Aaron Venouziou, MD
OrthopaedicHand and Upper Extremity Surgeon
St. Luke’s Hospital
Thessaloniki
www.handsurgery.gr

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Introduction
Arthroscopic ulnohumeral / osteocapsular arthroplasty
•Removal of osteophytes
•Removal of any loose bodies
•Capsulectomy
•Restoration of motion & function
•Elimination / reduction pain

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Pathoanatomy
Typical locations of osteophytes
•Olecranon
•Olecranon fossa
•Coronoidprocess
•Coronoidfossa
•Radial head
Anterior and posterior capsule contracture

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Indications
•Primary osteoarthritis
•Post-traumatic arthritis
•Arthritis after OCD
•Rheumatoid arthritis

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Contraindications
•Inadequate experience on elbow scope
•Prior ulnar nerve transposition
•Severe post-traumatic arthritis
•Severe joint surface irregularities

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Patient Evaluation
•Laborers and athletes
•Pain at the end of motion
•Loss of full extension
•Flexion contracture
•Crepitus / locking
•Ulnar neuritis symptoms
History

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Patient Evaluation
•Posterior Impingement Test
•Arm Bar Test
Clinical Examination

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Imaging
X-rays CT scan
3D

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Arthroscopic Technique
•Lateral decubitus
•Arm holder
•Shoulder forward flexed at 90o
•Shoulder slightly abducted
•Non-sterile tourniquet
Positioning

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Arthroscopic Technique
•4-mm, 30-degree scope
•Arthroscopic retractors and graspers
•Standard shaver and burr
•Suction is placed to gravity only
Equipment

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Arthroscopic Technique
• Get in and establish a view
•Create a space in which to work
•Bone removal
•Capsulectomy
General Rules

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Arthroscopic Technique
•Posterior Joint Compartment
•Medial Gutter
•Lateral Gutter
•Anterior Joint Compartment
Sequence of Elbow Scope

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Arthroscopic Technique
•Olecranon
•Lat. Epicondyle
•Radial head
•Med. Epicondyle
•Ulnar nerve
Landmarks

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Arthroscopic Technique
1. Get in: posterior, posterolateral, direct
midlateral portals
2. Create space: synovectomy, removal
of debris, scar tissue, and loose bodies
3. Bone removal: osteophytesfrom
olecranon tip & fossa
4. Capsulectomy:use large shaver
Posterior Joint Compartment

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Arthroscopic Technique
Medial Gutter
1. Get in: posterolateral viewing portal,
posterior working portal
2. Create space:synovectomy, stay away
from the ulnar nerve
3. Bone removal:osteophytes from
posteromedial olecranon w/ shaver
4. Posteromedial capsulectomy:⬆ flexion

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Arthroscopic Technique
Lateral Gutter
1. Get in: posterior viewing portal,
posterolateral working portal
2. Create space:synovectomy, use of soft
spot portal & RF device
3. Bone removal:posterior capitellum, lateral
trochlea and olecranon, loose bodies
4. Posterolateral capsulectomy:⬆ flexion

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Arthroscopic Technique
Anterior Joint Compartment
1. Get in: anterolateral & anteromedial
portals, accessories portals for retractors
2. Create space:synovectomy, scar tissue &
loose bodies removal
3. Bone removal:osteophytes from the
coronoid tip / fossa and radial fossa
4. Anterior capsulectomy:medial ➡ lateral

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Management of the Ulnar Nerve
•Preoperative ulnar nerve symptoms
•Large restoration of motion
•Preoperative flexion < 100o
When to perform a release:

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Postoperative Care
• Posterior splint in full extension
• On postop day 5 full active ROM
with no limitations is permitted
• Static progressive (turnbuckle)
splint for 4-6 weeks
• PT for 2-3 months

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Conclusions
• Overall, arthroscopic treatment of the arthritic
elbow yields very good pain relief and significant
improvement in joint range of motion
• Indications still depend on surgeon’s arthroscopic
skills
• Proceed cautiously and remember that
WHEN IN DOUBT GET OUT

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