A Literature Synthesis Indicates Very Low Quality, but Consistent Evidence of Improvements in Function after Surgical Interventions for Primary Osteoarthritis of the Elbow

Background. Primary osteoarthritis of the elbow is a debilitating disease with an overall incidence of about 2%. Pain and reduced motion (ROM) lead to disability and loss of functional independence. Purpose. To critically review the literature on patient-related important functional outcomes (pain, ROMs and functional recovery) after surgery for primary OA of the elbow, utilizing the 2011 OCEBM levels of evidence. Design. A literature synthesis. Results. Twenty-six articles satisfied the inclusion and exclusion criteria; 25 of the studies were at level IV evidence, and 1 at level III. All three surgical techniques led to improvement in pain, ROM, and functional recovery in the short- and medium-term follow-up. Long-term follow-up results, available only for open joint debridement, showed recurrence of osteoarthritic signs on X-ray with minimal loss of motion. Recently, there seems to be an increased focus on arthroscopic debridement. Conclusion. The quality of research addressing surgical interventions is very low, including total elbow arthroplasty (TEA). However, the evidence concurs that open and arthroscopic joint debridement can improve function in patients with moderate-to-severe OA of the elbow. TEA is reserved for treating severe joint destruction, mostly for elderly individuals with low physical demands when other intervention options have failed. 1. Introduction Primary OA of the elbow is a debilitating disease with an overall incidence of around 2% [1]. Men are more commonly affected than women at a ratio of 4？:？1 [2–4]. Primary OA of the elbow has had less focus than lower extremity joint arthritis, but can cause substantial disability. “Elbow arthritis” is an umbrella term, which would include rheumatoid arthritis, haemophilic arthritis, posttraumatic arthritis, septic arthritis, and crystalline arthropathy. Primary OA of the elbow can be difficult to differentiate from posttraumatic arthritis [2], and the reconstructive approaches are similar. The impairments most commonly associated with primary OA are pain, and loss of joint motion, strength, and function. In the management of primary OA of the elbow, surgical interventions are used when conservative measures like physiotherapy and medical management fail. The most common indications for surgery are end range pain, stiffness, loose bodies, and locking of the elbow joint. There are a number of surgical options available for the management of primary OA of the elbow. The preferred surgical options depend on the dominant clinical feature and radiographic changes [5]. The earliest evidence