Long-term survivorship of open débridement and débridement arthroplasty for elbow arthritis: a retrospective chart review.

Open débridement and Outerbridge-Kashiwagi (OK) débridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis, but little is known about their long-term survivorship. The purpose of this study was to determine whether survivorship until conversion to total elbow replacement and revision surgery was better for the OK procedure compared with open débridement. We performed a retrospective chart review of patients who underwent open elbow surgical débridement (open débridement or OK procedure) between 2000 and 2015. Patients received a diagnosis of primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients underwent surgery including open débridement (n = 142) or the OK procedure (n = 178), and of these patients, 33 required secondary revision surgery (open débridement, n = 14; OK procedure, n = 19). The average time since surgery was 11.5 years (range, 5.5-21.5 years). Survivorship was analyzed with Kaplan-Meier curves and the log rank test. A Cox proportional hazards model was used to estimate the effect of the type of procedure, index diagnosis, age, and sex on survivorship. Kaplan-Meier survival curves showed survivorship rates until total elbow arthroplasty of 100.0% at 1 year, 99.3% at 5 years, and 98.5% at 10 years for open débridement and 100.0% at 1 year, 98.8% at 5 years, and 98.0% at 10 years for the OK procedure (P = .87). There was no difference in survivorship between procedures, even after adjustment for significant covariates. The rates of revision for open débridement and the OK procedure were similar, at 11.3% and 11.5%, respectively, after 10 years. Higher rates of revision surgery were observed in patients who underwent open débridement (hazard ratio, 4.84; 95% confidence interval, 1.29-18.17; P = .019) compared with those who underwent the OK procedure after adjustment for covariates. We performed a stratified analysis with radiographic severity as an effect modifier and showed that patients with grade 3 arthritis fared better after the OK procedure compared with open débridement in terms of survivorship until revision surgery (P = .05). However, such a difference was not found for grade 1 or grade 2 arthritis. We showed that both open elbow débridement and the OK procedure had excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post-traumatic cases that could help delay the need for total elbow arthroplasty. Patients with more severe radiographic arthritis, specifically grade 3 arthritis, were less likely to require revision surgery if treated initially with the OK procedure compared with open débridement. Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Citation

Jimmy Tat, Milena Vicente, Jeremy Hall. Long-term survivorship of open débridement and débridement arthroplasty for elbow arthritis: a retrospective chart review. Journal of shoulder and elbow surgery. 2022 Aug;31(8):1571-1580

Mesh Tags

PMID: 35189372

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