ELBOW OSTEOARTHRITIS. PROGNOSTIC INDICATORS IN ULNOHUMERAL DEBRIDEMENT (OUTERBRIDGE - KASHIWAGI PROCEDURE)

Abstract

Since described by Kashiwagi in 1978, the Outerbridge - Kashiwagi procedure (OK procedure) has been used to treat osteoarthritis of the elbow when simple measures have failed. Despite being used for 20 years, there have been surprisingly few series. The aim of this study was to assess the medium to long term results of the OK procedure and to analyse the preoperative and operative findings to identify features which predict a good outcome.

A consecutive series of 43 patients (44 elbows) underwent ulnohumeral debridement (OK procedure) for osteoarthritis of the elbow. Their mean age was 57 years (range 24 – 85 years) with one female patient. 35 patients (36 elbows) were reviewed after a mean follow up of 39 months (range 12 – 71 months). Overall, 81% of patients were satisfied with 12 good, 19 fair and 5 poor outcomes. The mean arc of flexion/extension (p=0.001), pain score (p=0.002) and locking (p=0.003) were significantly improved but a significant number of patients developed rest pain (p< 0.0001). There was a complication rate of 17% (2 ulna nerve entrapment, 1 ulna nerve neuropraxia which resolved completely, 1 superficial wound infection, 1 wound haematoma and 1 myocardial infarction). The reoperation rate was 8% (2 revision OK procedures and 1 ulna nerve decompression).

Patients with symptoms for less than 2 years, considerable preoperative pain or cubital tunnel syndrome had a significantly increased chance of a good outcome. The absence of preoperative locking was associated with a significantly increased chance of a poor outcome. Joint space narrowing on radiographs or presence of posterior loose bodies at operation was associated with an increased chance of a good outcome but these were not statistically significant. A history of trauma, the preoperative range of movement and Xray score did not predict outcome.