Systematic Review| Volume 37, ISSUE 2, P747-758.e1, February 2021

A Systematic Review of Arthroscopic Versus Open Debridement of the Arthritic Elbow

Published:September 16, 2020DOI:


      To systematically review the available data with regard to clinical and functional outcomes of arthroscopic and open debridement for elbow arthritis to determine the complication rate with transition to arthroscopic surgery.


      Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses protocol, a systematic review was performed including studies reporting clinical and functional outcomes following open or arthroscopic debridement of elbow arthritis. The primary outcome measures analyzed were functional outcome (Mayo Elbow Performance Score), range of motion, and complication rate. Data were extracted for the whole group and then compared between the techniques using ranges and forest plots.


      In total, 39 level IV and 3 level III studies with 1097 elbows were eligible for inclusion; 684 elbows were treated using an open technique and 413 using an arthroscopic technique. Regarding functional outcome scores, mean Mayo Elbow Performance Score improved significantly with comparable magnitude of improvement in both groups (arthroscopic group: range 28-34, open group: range 25-31). Regarding range of motion, mean flexion–extension arc improved significantly in both groups (arthroscopic group: range 8-26°, open group: range 13-49°). The open group had a lower preoperative flexion–extension arc (range 63-96) in comparison with the arthroscopic group (range 84-119). The overall incidence of complications was 5.7% (range 0%-19%) in the arthroscopic group and 6.1% (range 0%-25%) in the open group. The most common complication type was neurologic, with an incidence of 2.1% (range 0%-8%) in the arthroscopic group and 1.9% (range 0%-12%) in the open group. The deep infection rate was 0.7% (range 0%-10%) in the open group with no reported incidence in the arthroscopic group.


      This systematic review demonstrated good mid-term functional outcomes following debridement arthroplasty of the arthritic elbow. There was no increase in complications with an arthroscopic technique confirming its safety and efficacy.

      Level of Evidence

      IV, Systematic Review of Level III and IV articles.
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        • Papatheodorou L.K.
        • Baratz M.E.
        • Sotereanos D.G.
        Elbow arthritis: Current concepts.
        J Hand Surg Am. 2013; 38: 605-613
        • Galle S.E.
        • Beck J.D.
        • Burchette R.J.
        • Harness N.G.
        Outcomes of elbow arthroscopic osteocapsular arthroplasty.
        J Hand Surg Am. 2016; 41: 184-191
        • Stanley D.
        Prevalence and etiology of symptomatic elbow osteoarthritis.
        J Shoulder Elbow Surg. 1994; 3: 386-389
        • Scott D.L.
        • Wolfe F.
        • Huizinga T.W.J.
        Rheumatoid arthritis.
        Lancet. 2010; 376: 1094-1108
        • Jenkins P.J.
        • Watts A.C.
        • Norwood T.
        • Duckworth A.D.
        • Rymaszewski L.A.
        • McEachan J.E.
        Total elbow replacement: Outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project.
        Acta Orthop. 2013; 84: 119-123
        • Fevang B.T.S.
        • Lie S.A.
        • Havelin L.I.
        • Skredderstuen A.
        • Furnes O.
        Results after 562 total elbow replacements: A report from the Norwegian Arthroplasty Register.
        J Shoulder Elbow Surg. 2009; 18: 449-456
        • Kelikian H.
        Surgery in the treatment of chronic arthritis.
        Surg Clin North Am. 1949; 29: 87-115
        • Kashiwagi D.
        Intraarticular changes of the osteoarthritic elbow, especially about the fossa olecrani.
        J Jph Orthop Assoc. 1978; 52: 1367-1368
        • Morrey B.F.
        Primary degenerative arthritis of the elbow: Treatment by ulnohumeral arthroplasty.
        J Bone Joint Surg Br. 1992; 74: 409-413
        • Burman M.S.
        Arthroscopicy or the direct visulaization of joints, an experimantal cadaver study.
        J Bone Joint Surg Br. 1931; 13: 669-695
        • Kim S.J.
        • Moon H.K.
        • Chun Y.M.
        • Chang J.H.
        Arthroscopic treatment for limitation of motion of the elbow: The learning curve.
        Knee Surg Sport Traumatol Arthrosc. 2011; 19: 1013-1018
        • Redden J.F.
        • Stanley D.
        Arthroscopic fenestration of the olecranon fossa in the treatment of osteoarthritis of the elbow.
        Arthroscopy. 1993; 9: 14-16
        • Tsuge K.
        • Mizuseki T.
        Debridement arthroplasty for advanced primary osteoarthritis of the elbow. Results of a new technique used for 29 elbows.
        J Bone Joint Surg Br. 1994; 76: 641-646
        • Savoie 3rd, F.H.
        • Nunley P.D.
        • Field L.D.
        Arthroscopic management of the arthritic elbow: indications, technique, and results.
        J Shoulder Elbow Surg. 1999; 8: 214-219
        • Cohen A.P.
        • Redden J.F.
        • Stanley D.
        Treatment of osteoarthritis of the elbow: A comparison of open and arthroscopic debridement.
        Arthroscopy. 2000; 16: 701-706
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.
        PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Checklist.
        PLoS Med. 2009; 6e1000097
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Higgins J.P.T.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Ruch D.S.
        • Poehling G.G.
        Anterior interosseus nerve injury following elbow arthroscopy.
        Arthroscopy. 1997; 13: 756-758
        • Rettig L.A.
        • Hastings H.
        • Feinberg J.R.
        Primary osteoarthritis of the elbow: Lack of radiographic evidence for morphologic predisposition, results of operative debridement at intermediate follow-up, and basis for a new radiographic classification system.
        J Shoulder Elbow Surg. 2008; 17: 97-105
        • Raval P.
        • Ellanti P.
        • Harrington P.
        Ulnohumeral debridement arthroplasty: A retrospective study and midterm outcome results.
        Eur J Orthop Surg Traumatol. 2015; 25: 847-850
        • Phillips N.J.
        • Ali A.
        • Stanley D.
        Treatment of primary degenerative arthritis of the elbow by ulnohumeral arthroplasty. A long-term follow-up.
        J Bone Joint Surg Br. 2003; 85: 347-350
        • Oka Y.
        • Kazutoshi O.
        • Ikuo S.
        Debridement arthroplasty for osteoarthritis of the elbow.
        Clin Orthop Relat Res. 1998; 351: 127-134
        • Oka Y.
        Debridement arthroplasty for osteoarthrosis of the elbow: 50 patients followed mean 5 years.
        Acta Orthop Scand. 2000; 71: 185-190
        • Oka Y.
        Debridement for osteoarthritis of the elbow in athletes.
        Int Orthop. 1999; 23: 91-94
        • Ogilvie-Harris D.J.
        • Gordon R.
        • MacKay M.
        Arthroscopic treatment for posterior impingement in degenerative arthritis of the elbow.
        Arthroscopy. 1995; 11: 437-443
        • Miyake J.
        • Shimada K.
        • Oka K.
        • et al.
        Arthroscopic debridement in the treatment of patients with osteoarthritis of the elbow, based on computer simulation.
        Bone Joint J. 2014; 96-B: 237-241
        • Minami M.
        • Kato S.
        • Kashiwagi D.
        Outerbridge-Kashiwagi’s method for arthroplasty of osteoarthritis of the elbow 44 elbows followed for 8-16 years.
        J Orthop Sci. 1996; : 11-15
        • Merolla G.
        • Buononato C.
        • Chillemi C.
        • Paladini P.
        • Porcellini G.
        Arthroscopic joint debridement and capsular release in primary and post-traumatic elbow osteoarthritis: a retrospective blinded cohort study with minimum 24-month follow-up.
        Musculoskelet Surg. 2015; 99: S83-S90
        • MacLean S.B.
        • Oni T.
        • Crawford L.A.
        • Deshmukh S.C.
        Medium-term results of arthroscopic debridement and capsulectomy for the treatment of elbow osteoarthritis.
        J Shoulder Elbow Surg. 2013; 22: 653-657
        • Lim T.K.
        • Koh K.H.
        • Lee H Il
        • Shim J.W.
        • Park M.J.
        Arthroscopic débridement for primary osteoarthritis of the elbow: Analysis of preoperative factors affecting outcome.
        J Shoulder Elbow Surg. 2014; 23: 1381-1387
        • Krishnan S.G.
        • Harkins D.C.
        • Pennington S.D.
        • Harrison D.K.
        • Burkhead W.Z.
        Arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in patients under fifty years of age.
        J Shoulder Elbow Surg. 2007; 16: 443-448
        • Kovachevich R.
        • Steinmann S.P.
        Arthroscopic ulnar nerve decompression in the setting of elbow osteoarthritis.
        J Hand Surg Am. 2012; 37: 663-668
        • Kelly E.W.
        • Bryce R.
        • Coghlan J.
        • Bell S.
        Arthroscopic debridement without radial head excision of the osteoarthritic elbow.
        Arthroscopy. 2007; 23: 151-156
        • Jeon I.-H.
        • Lee S.-M.
        • Kim P.-T.
        Acute ulnar nerve palsy after Outerbridge-Kashiwagi procedure.
        J Hand Surg Eur Vol. 2007; 32: 596
        • Inglis A.E.
        • Ranawat C.S.
        • Straub L.R.
        Synovectomy and debridement of the elbow in rheumatoid arthritis.
        J Bone Joint Surg. 1971; 53-A: 652-662
        • Hearnden A.
        • Talwalkar S.C.
        • Roy N.
        • et al.
        Ulnohumeral arthroplasty in the management of the arthritic elbow.
        Shoulder Elbow. 2009; 1: 95-98
        • Hattori Y.
        • Doi K.
        • Sakamoto S.
        • Hoshino S.
        • Dodakundi C.
        Capsulectomy and debridement for primary osteoarthritis of the elbow through a medial trans-flexor approach.
        J Hand Surg Am. 2011; 36: 1652-1658
        • Gofton W.T.
        • King G.J.
        Heterotopic ossification following elbow arthroscopy.
        Arthroscopy. 2001; 17: E2
        • Forster M.C.
        • Clark D.I.
        • Lunn P.G.
        Elbow osteoarthritis: Prognostic indicators in ulnohumeral debridement—the Outerbridge-Kashiwagi procedure.
        J Shoulder Elbow Surg. 2001; 10: 557-560
        • Degreef I.
        • Samorjai N.
        • De Smet L.
        The Outerbridge-Kashiwaghi procedure in elbow arthroscopy.
        Acta Orthop Belg. 2010; 76: 468-471
        • Chandrasenan J.
        • Dias R.
        • Lunn P.G.
        Heterotopic ossification after the Outerbridge-Kashiwagi procedure in the elbow.
        J shoulder Elbow Surg. 2008; 17: e15-e17
        • Antuna S.A.
        • Morrey B.F.
        • Adams R.A.
        • O’Driscoll S.W.
        Ulnohumeral arthroplasty for primary degenerative arthritis of the elbow: Long-term outcome and complications.
        J Bone Joint Surg Am. 2002; 84: 2168-2173
        • Allen D.M.
        • Devries J.P.
        • Nunley J.A.
        Ulnohumeral arthroplasty.
        Iowa Orthop J. 2004; 24: 49-52
        • Al Hussainy H.
        • Hekal W.
        • Farhan M.J.
        The Outerbridge-Kashiwagi procedure for osteoarthritis of the elbow: Do site and number of loose bodies matter to the outcome?.
        Eur J Orthop Surg Traumatol. 2005; 15: 129-134
        • Adams J.E.
        • Wolff 3rd, L.H.
        • Merten S.M.
        • Steinmann S.P.
        Osteoarthritis of the elbow: Results of arthroscopic osteophyte resection and capsulectomy.
        J Shoulder Elbow Surg. 2008; 17: 126-131
        • Tsuge K.
        • Murakami Y.
        • Yasunaga Y.
        • Kanayujia R.R.
        Arthroplasty of the elbow. Twenty years’ experience of a new approach.
        J Bone Joint Surg. 1987; 69: 116-120
        • Wada T.
        • Isogai S.
        • Ishii S.
        • Yamashita T.
        Débridement arthroplasty for primary osteoarthritis of the elbow.
        J Bone Joint Surg Am. 2004; 86-A: 233-241
        • Vingerhoeds B.
        • Degreef I.
        • De Smet L.
        Debridement arthroplasty for osteoarthritis of the elbow (Outerbridge-Kashiwagi procedure).
        Acta Orthop Belg. 2004; 70: 306-310
        • Ugurlu M.
        • Senkoylu A.
        • Ozsoy H.
        • Demirkale I.
        • Kilicarslan K.
        • Dogan M.
        Outcome of ulnohumeral arthroplasty in osteoarthritis of the elbow.
        Acta Orthop Belg. 2009; 75: 606-610
        • Tashjian R.Z.
        • Wolf J.M.
        • Ritter M.
        • Weiss A.-P.
        • Green A.
        Functional outcomes and general health status after ulnohumeral arthroplasty for primary degenerative arthritis of the elbow.
        J Shoulder Elbow Surg. 2006; 15: 357-366
        • Sarris I.
        • Riano F a
        • Goebel F.
        • Goitz R.J.
        • Sotereanos D.G.
        Ulnohumeral arthroplasty: Results in primary degenerative arthritis of the elbow.
        Clin Orthop Relat Res. 2004; 420: 190-193
        • Cha S.-M.
        • Shin H.-D.
        • Kim K.-C.
        • Park I.-Y.
        Outcomes of the mini-open Outerbridge-Kashiwagi procedure according to preoperative radiocapitellar joint status.
        J Hand Surg Am. 2014; 39: 209-218
        • Kim S.J.
        • Kim J.W.
        • Lee S.H.
        • Choi J.W.
        Retrospective comparative analysis of elbow arthroscopy used to treat primary osteoarthritis with and without release of the posterior band of the medial collateral ligament.
        Arthroscopy. 2017; 33: 1506-1511
        • Morrey B.F.
        • Bryan R.S.
        • Dobyns J.H.
        • Linscheid R.L.
        Total elbow arthroplasty. A five-year experience at the Mayo Clinic.
        J Bone Joint Surg Am. 1981; 63: 1050-1063
        • Morrey B.F.
        • Askew L.J.
        • Chao E.Y.
        A biomechanical study of normal functional elbow motion.
        J Bone Joint Surg Am. 1981; 63: 872-877
        • Larson A.N.
        • Morrey B.F.
        Interposition arthroplasty with an achilles tendon allograft as a salvage procedure for the elbow.
        J Bone Joint Surg Am. 2008; 90: 2714-2723
        • Laubscher M.
        • Vochteloo A.J.
        • Smit A.A.
        • Vrettos B.C.
        • Roche S.J.
        A retrospective review of a series of interposition arthroplasties of the elbow.
        Shoulder Elbow. 2014; 6: 129-133
        • Saleh K.
        • Olson M.
        • Resig S.
        • et al.
        Predictors of wound infection in hip and knee joint replacement:Results from a 20 year surveillance program.
        J Orthop Res. 2002; 20: 506-515
        • 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
        • Guerrero E.M.
        • Helmkamp J.K.
        • Bullock G.S.
        • et al.
        The clinical impact of different approaches to osteocapsular debridement for primary osteoarthritis of the elbow: A systematic review.
        J Shoulder Elbow Surg. 2020; 29: e171
        • Dhawan A.
        • Brand J.C.
        • Provencher M.T.
        • Rossi M.J.
        • Lubowitz J.H.
        Research pearls: The significance of statistics and perils of pooling.
        Arthroscopy. 2017; 33: 1099-1101