Arthroscopic excision of the radial head: Clinical outcome in 12 patients with post-traumatic arthritis after fracture of the radial head or rheumatoid arthritis.

PURPOSE: We performed arthroscopic radial head excision in a series of patients with either post-traumatic arthritis after a radial head fracture or rheumatoid arthritis of the elbow as an expanded indication for elbow arthroscopy. The purpose of the study was to critically examine the results of arthroscopic chondroplasty of the radial head to determine the safety and effectiveness of the procedure. TYPE OF STUDY: Outcome study and retrospective analysis.
METHODS: From 1990 to 1997, arthroscopic radial head resection was performed in 12 patients with either post-traumatic arthritis (n = 10, Mason type II or III) or with rheumatoid arthritis (n = 2). Functional outcome and radiographs were analyzed after a mean follow-up period of 39 months (range, 12 to 97 months). Elbow arthroscopy was performed using a standardized technique. The anterior three quarters of the radial head and 2 to 3 mm of the radial neck were resected with the abrader in the anterolateral portal and the arthroscope in the proximal medial portal. For resection of the posterior portion of the radial head, the abrader may be transferred to the mediolateral portal. This permits resection of the remnants of the radial head posteriorly and also at the proximal radioulnar joint.
RESULTS: Preoperatively, patients lacked 23 degrees (range, 5 degrees to 40 degrees ) of extension of the elbow on average. Mean flexion was 111 degrees (range, 60 degrees to 145 degrees ). Patients had unrestricted pronation (limitation of 5 degrees in 2 patients). Two patients had a lack of supination of 15 degrees and 30 degrees. Mean follow up was 39 months (range, 12 to 97 months). Postoperatively, patients lacked 9 degrees (range, 0 degrees to 20 degrees ) of extension of the elbow on average. Mean flexion was 136 degrees (range, 90 degrees to 150 degrees ). No patient had subjective or objective evidence of instability of the elbow. All patients except one reported significant improvement in pain relief and complete relief of mechanical symptoms.
CONCLUSIONS: This technically demanding surgical procedure should be reserved for situations of persistent, restricted range of motion and chronic pain. Arthroscopic radial head resection combined with arthroscopic synovectomy relieves elbow stiffness. The surgeon is able to deal with the intrinsic joint pathology, as well as with accompanying symptoms such as synovitis, capsular contracture, or loose bodies.