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Elbow Arthrosis: Algorithm for Treatment

Robert Taylor United States

Suspected Elbow Arthrosis

Radiographic Signs

Lameness ¯ Effusion
Pain with Palpation—Muscle Atrophy
¯

Confirm diagnosis

Arthroscopy
MR
CT
¯

Assessment Questions

Bicompartment Disease
Age of Patient/ Intended Use
Degree of Osteochondral Damage
Severity of Radiographic Lesions

Isolated U.A.P.

Isolated F.C.P.

+ Surgical removal

Arthroscopic removal

Dynamic ulnar osteotomy

Radial lenthening
Limb realignment (Slocum)

UAP and Osteochondrosis

FCD and Osteochondrosis

+ Surgical removal

Arthroscopic removal/debridement

Debridement (arthroscopy)

Limb realignment (Slocum)

Radial shortening

Radial lengthening

+ Dynamic ulnar osteotomy

+ Resurfacing

+ Resurfacing

Moderate To Severe Elbow D.J.D.

+ UAP + FCP + Osteochondrosis
Limb realignment (Slocum)—Orthroscopic debridement
Resurfacing procedures—NSAIDS chondroprotectives
Total joint replacement + arthrodesis

UAP

Age/ status of joint
Prognosis

1.   Arthroscopy—diagnosis—assess joint

2.   Proximal dynamic ulnar osteotomy

3.   + IM pin—location of ulnar osteotomy varies

Surgical removal

Progressive DJD
Good to excellent limb usage 6/7 (Roy)

Ulnar osteotomy

21/22 VAP united (Sjöström)
28% excellent results (Gilson)

FCP

Age/ status of joint

1.   Arthroscopy—preferred method of diagnosis/treatment

2.   Radial lengthening—limb realignment (Slocum Elbow Group)

Surgical removal—improvement in gait/ progressive DJD (Theyse)

Osteochondrosis

Age/ status of joint

1.   Arthroscopy—diagnosis and treatment

2.   Radial lengthening—limb realignment (Slocum Elbow Group)

3.   Resurfacing technique

Resurfacing Technique

Open arthrotomy—osteotomy of medial epicondyle
Autograft or allograft
4-8mm osteochondral plugs
Donor plugs impacted into recipient sites

Pros:

  Good survivability of cartilage

  Actual resurfacing

Cons:

  Technically difficult

  Expensive technology

Notes


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