Range-of-motion improvement and complication rate in open and arthroscopic osteocapsular arthroplasty for primary osteoarthritis of the elbow: a systematic review

Purpose

To analyze ROM changes by using a Bayesian method, to compare complication and re-operation rates between open osteocapsular arthroplasty (OPEN) and arthroscopic osteocapsular arthroplasty (ARTHRO) for primary osteoarthritis of the elbow, and find evidence-based tendencies.

Methods

The PubMed, Cochrane Library, and Embase databases were searched. We performed descriptive analysis to compare ARTHRO and OPEN, a Bayesian analysis of ROM changes, and methodological assessment to determine the tendencies of OPEN and ARTHRO.

Results

Eighteen articles (625 patients, 634 elbows) were analyzed. There were 11 articles on OPEN and 8 articles on ARTHRO (1 article was a comparative study between OPEN and ARTHRO). According to the Bayesian method, flexion and total arc of flexion-extension increased more with OPEN than with ARTHRO. Further, ARTHRO showed a narrower width in the ROM graph than OPEN. The number of complications was 17 (5.1%) and five (2.0%), and the number of re-operations was 32 (9.5%) and 14 (5.6%) for OPEN and ARTHRO, respectively. By analyzing six high-quality articles, we found three tendencies: OPEN and ARTHRO were both effective for improving pain score, flexion-extension arc, and functional outcome; OPEN did not improve the pronation-supination arc; and there was a weak tendency that OPEN was more effective than ARTHRO for improving the flexion arc.

Conclusion

Both OPEN and ARTHRO improved ROM and clinical scores. The Bayesian method indicated that although OPEN increased the flexion and flexion-extension arc more than ARTHRO, ARTHRO resulted in a relatively consistent surgical outcome. Additionally, OPEN caused relatively higher complication and re-operation rates than ARTHRO.