ArthroscopicTreatmentoftheArthriticElbow

AaronVenouziou,MDOrthopaedicHandandUpperExtremitySurgeon

St.Luke’sHospitalThessaloniki

www.handsurgery.gr

www.handsurgery.gr

Introduction

Arthroscopiculnohumeral /osteocapsular arthroplasty

•Removalofosteophytes

•Removalofanyloosebodies

•Capsulectomy

•Restorationofmotion&function

•Elimination/reductionpain

www.handsurgery.gr

Pathoanatomy

Typicallocationsofosteophytes

•Olecranon

•Olecranon fossa

•Coronoidprocess

•Coronoid fossa

•Radialhead

Anteriorandposteriorcapsulecontracture

www.handsurgery.gr

Indications

•Primaryosteoarthritis

•Post-traumaticarthritis

•ArthritisafterOCD

•Rheumatoidarthritis

www.handsurgery.gr

Contraindications

•Inadequateexperienceonelbowscope

•Priorulnarnervetransposition

•Severepost-traumaticarthritis

•Severejointsurfaceirregularities

www.handsurgery.gr

PatientEvaluation

•Laborers andathletes

•Painattheendofmotion

•Lossoffullextension

•Flexioncontracture

•Crepitus /locking

•Ulnarneuritissymptoms

History

www.handsurgery.gr

PatientEvaluation

•PosteriorImpingementTest

•ArmBarTest

ClinicalExamination

www.handsurgery.gr

Imaging

X-rays CTscan3D

www.handsurgery.gr

ArthroscopicTechnique

•Lateraldecubitus

•Armholder

•Shoulderforwardflexedat90o

•Shoulderslightlyabducted

•Non-steriletourniquet

Positioning

www.handsurgery.gr

ArthroscopicTechnique

•4-mm,30-degreescope

•Arthroscopicretractorsandgraspers

•Standardshaverandburr

•Suctionisplacedtogravityonly

Equipment

www.handsurgery.gr

ArthroscopicTechnique

• Getinandestablishaview

•Createaspaceinwhichtowork

•Boneremoval

•Capsulectomy

GeneralRules

www.handsurgery.gr

ArthroscopicTechnique

•PosteriorJointCompartment

•MedialGutter

•LateralGutter

•AnteriorJointCompartment

SequenceofElbowScope

www.handsurgery.gr

ArthroscopicTechnique

•Olecranon

•Lat.Epicondyle

•Radialhead

•Med.Epicondyle

•Ulnarnerve

Landmarks

www.handsurgery.gr

ArthroscopicTechnique

1. Getin: posterior,posterolateral,direct

midlateral portals

2. Createspace: synovectomy,removal

ofdebris,scartissue,andloosebodies

3. Boneremoval: osteophytesfrom

olecranon tip&fossa

4. Capsulectomy: uselargeshaver

PosteriorJointCompartment

www.handsurgery.gr

ArthroscopicTechnique

MedialGutter

1. Getin: posterolateralviewingportal,

posteriorworkingportal

2. Createspace: synovectomy,stayaway

fromtheulnarnerve

3. Boneremoval: osteophytesfrom

posteromedialolecranonw/shaver

4. Posteromedialcapsulectomy:⬆ flexion

www.handsurgery.gr

ArthroscopicTechnique

LateralGutter

1. Getin: posteriorviewingportal,

posterolateralworkingportal

2. Createspace: synovectomy,useofsoft

spotportal&RFdevice

3. Boneremoval: posteriorcapitellum,lateral

trochleaandolecranon,loosebodies

4. Posterolateralcapsulectomy:⬆ flexion

www.handsurgery.gr

ArthroscopicTechnique

AnteriorJointCompartment

1. Getin: anterolateral&anteromedial

portals,accessoriesportalsforretractors

2. Createspace: synovectomy,scartissue&

loosebodiesremoval

3. Boneremoval: osteophytesfromthe

coronoidtip/fossaandradialfossa

4. Anteriorcapsulectomy:medial➡ lateral

www.handsurgery.gr

ManagementoftheUlnarNerve

•Preoperativeulnarnervesymptoms

•Largerestorationofmotion

•Preoperativeflexion<100o

Whentoperformarelease:

www.handsurgery.gr

PostoperativeCare

• Posteriorsplintinfullextension

• Onpostopday5fullactiveROM

withnolimitationsispermitted

• Staticprogressive(turnbuckle)

splintfor4-6weeks

• PTfor2-3months

www.handsurgery.gr

Conclusions

• Overall,arthroscopictreatmentofthearthritic

elbowyieldsverygoodpainreliefandsignificant

improvementinjointrangeofmotion

• Indicationsstilldependonsurgeon’sarthroscopic

skills

• Proceedcautiouslyandrememberthat

WHENINDOUBTGETOUT

www.handsurgery.gr