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

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 (Sj�str�m)
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