Surgical therapies for elbow arthritis include open débridement and Outerbridge and Kashiwagi débridement arthroplasty (OK procedure), although little is known regarding long-term outcomes. This study aimed to see if the OK method had a better survival rate than open débridement when converting to total elbow replacement and revision surgery. Between 2000 and 2015, Researchers reviewed the medical records of individuals who had open elbow surgical débridement (open débridement, OK technique). Primary elbow osteoarthritis, post-traumatic arthritis, and inflammatory arthritis were all diagnosed in the patients. A total of 320 patients had surgery, including open débridement (n=142) and the OK technique (n=178), with 33 requiring subsequent revision surgery (open débridement, n=14, and OK procedure, n=19). It had been 11.5 years since surgery on average (5.5 – 21.5 years). Kaplan-Meier curves and the Log Rank test were used to assess survival. The influence of procedure, index diagnosis, age, and gender on survivorship was estimated using the Cox proportional hazards model.
Open débridement had a success rate of 100.00% at one year, 99.25% at five years, and 98.49% at ten years, while the OK procedure had a success rate of 100.00% at one year, 98.80% at five years, and 97.97% at ten years (p=0.87) for conversion to total elbow arthroplasty. Even after controlling for major confounders, there was no difference in survival between methods. After ten years, the revision rates for open débridement and OK treatment were identical, with 11.31% and 11.48%, respectively. After controlling for confounders, patients with open débridement had a greater rate of revision surgery (hazard ratio, 4.84 CI 1.29 – 18.17, p=0.019) than those who had an OK treatment. Grade 3 arthritis did better with the OK method than open débridement for survivability until revision surgery (p=0.05), according to a stratified analysis with radiographic severity as an effect modifier. Researchers did not detect this distinction in the cases of grade 1 or grade 2 arthritis. Researchers found that open elbow débridement and the OK procedure had excellent survivorship until conversion to total elbow arthroplasty. They are viable options in treating primary elbow osteoarthritis and post-traumatic cases, potentially delaying the need for total elbow arthroplasty. Compared to open débridement, more severe radiographic arthritis, notably grade 3 arthritis, was less likely to require revision surgery if treated with the OK technique.
Reference:www.jshoulderelbow.org/article/S1058-2746(22)00234-8/fulltext#relatedArticles
