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