Complications of Elbow Arthroscopy in a Community-Based Practice

Published:November 27, 2019DOI:https://doi.org/10.1016/j.arthro.2019.11.108

      Purpose

      The purpose of this study was to report the complications of elbow arthroscopy in a large community practice with multiple surgeons and to analyze potential risk factors for these complications.

      Methods

      Patient demographic information, surgical variables, surgeon variables, and complications were retrospectively reviewed for all elbow arthroscopies performed within the health network from 2006 to 2014. Inclusion criteria included patients of any age undergoing a primary and revision elbow arthroscopy, which may have been performed in conjunction with other procedures. Exclusion criteria included incorrectly coded procedures where arthroscopy was not performed and no postoperative follow-up. Statistical calculations were performed using a binary logistic regression analysis to fit a logistic regression model.

      Results

      560 consecutive elbow arthroscopies in 528 patients performed between 2006 and 2014, by 42 surgeons at 14 facilities, were reviewed. 113 procedures were performed in pediatric patients under the age of 18. The average age was 38.6 years (range: 5-88). There were 444 males. The average length of follow-up was 375.8 days (2 to 2,739 days). Overall, heterotopic ossification occurred in 14 of 560 cases (2.5%) (all males), and 20 of 560 (3.5%) cases developed transient nerve palsies (8 ulnar, 8 radial, 1 median, 3 medial antebrachial cutaneous). There were 3 (0.5%) deep and 11 (2%) superficial infections. There were no vascular injuries, compartment syndrome, deep vein thrombosis, or pulmonary embolism. Elevated blood sugar was a significantly higher risk for infection (odds ratio [OR] 4.11, 95% confidence interval [CI] 1.337 to 12.645; P = .0136). Previous elbow surgery (OR 3.57, 95% CI 1.440 to 8.938; P = .006) and female sex (OR 4.05; 95% CI 1.642 to 9.970; P = .002) had a significantly higher risk for nerve injury. Relative to pediatric patients, there were higher odds in adults for nerve injury, infection, and heterotopic ossification, but none reached significance.

      Conclusions

      Elbow arthroscopy is a safe procedure with low complication rates. Diabetes is a risk factor for infection. Prior surgery and female sex are risk factors for nerve injury.

      Level of Evidence

      Case series, level 4
      To read this article in full you will need to make a payment
      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nelson G.N.
        • Wu T.
        • Galatz L.M.
        • Yamaguchi K.
        • Keener J.D.
        Elbow arthroscopy: Early complications and associated risk factors.
        J Shoulder Elbow Surg. 2014; 23: 273-278
        • Andrews J.R.
        • Carson W.G.
        Arthroscopy of the elbow.
        Arthroscopy. 1985; 1: 97-107
        • O’Driscoll S.W.
        • Morrey B.F.
        Arthroscopy of the elbow: Diagnostic and therapeutic benefits and hazards.
        J Bone Joint Surg Am. 1992; 74: 84-94
        • Reddy A.S.
        • Kvitne R.S.
        • Yocum L.A.
        • Elattrache N.S.
        • Glousman R.E.
        • Jobe F.W.
        Arthroscopy of the elbow: A long-term clinical review.
        Arthroscopy. 2000; 16: 588-594
        • Kelly E.W.
        • Morrey B.F.
        • O’Driscoll S.W.
        Complications of elbow arthroscopy.
        J Bone Joint Surg Am. 2001; 83: 25-34
        • Jinnah A.H.
        • Luo T.D.
        • Wiesler E.R.
        • et al.
        Peripheral nerve injury after elbow arthroscopy: An analysis of risk factors.
        Arthroscopy. 2018; 34: 1447-1452
        • Marti D.
        • Spross C.
        • Jost B.
        The first 100 elbow arthroscopies of one surgeon: Analysis of complications.
        J Shoulder Elbow Surg. 2013; 22: 567-573
        • Elfeddali R.
        • Schreuder M.H.
        • Eygendaal D.
        Arthroscopic elbow surgery, is it safe?.
        J Shoulder Elbow Surg. 2013; 22: 647-652
        • Schneider T.
        • Hoffstetter I.
        • Fink B.
        • Jerosch J.
        Long-term results of elbow arthroscopy in 67 patients.
        Acta Orthop Belg. 1994; 60: 378-383
        • Hilgersom N.F.J.
        • van Deurzen D.F.P.
        • Gerritsma C.L.E.
        • van der Heide H.J.L.
        • Malessy M.J.A.
        • Eygendaal D.
        • van den Bekerom M.P.J.
        Nerve injuries do occur in elbow arthroscopy.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 318-324
        • Desai M.J.
        • Mithani S.K.
        • Lodha S.J.
        • Richard M.J.
        • Leversedge F.J.
        • Ruch D.S.
        Major peripheral nerve injuries after elbow arthroscopy.
        Arthroscopy. 2016; 32: 999-1002
        • Campl C.L.
        • Cancienne J.M.
        • Degen R.M.
        • Dines J.S.
        • Altchek D.W.
        • Werner B.C.
        Factors that increase the risk of infection after elbow arthroscopy: Analysis of patient demographics, medical comorbidities, and steroid injections in 2,704 medicare patients.
        Arthroscopy. 2017; 33: 1175-1179
        • Andelman S.M.
        • Meier K.M.
        • Walsh A.L.
        • Hausman M.R.
        Pediatric elbow arthroscopy: Indications and safety.
        J Shoulder Elbow Surg. 2017; 26: 1862-1866
        • Vavken P.
        • Muller A.
        • Camathias C.
        First 50 pediatric and adolescent elbow arthroscopies: Analysis of indications and complications.
        J Pediatr Orthop. 2016; 36: 400-404
        • Micheli L.J.
        • Luke A.C.
        • Mintzer C.M.
        • Waters P.M.
        Elbow arthroscopy in the pediatric and adolescent population.
        Arthroscopy. 2001; 17: 694-699