Arthroscopic Partial Excision of the Radial Head for Advanced Rheumatoid Elbow

Abstract

We treated humeroradial joint disorder in rheumatoid elbows with arthroscopic partial excision of the radial head, in which the radial head is minimally resected under arthroscopy to ensure adequate joint space and articular congruity. To examine the effect of this method, we investigated outcomes using a retrospective case series. The hypothesis of this study was that this method decreases symptoms related to the humeroradial joint and ensures articular congruity. Since 2008, we have performed arthroscopic partial excision of the radial head for 14 patients (15 rheumatoid elbows) with more than 2 years of follow-up. Surgical indications for this method were motion pain with crepitus around the humeroradial joint and joint narrowing and sclerosis on plain radiography. After synovectomy, the surface of the radial head was resected 4 to 5 mm under arthroscopy, ensuring adequate joint space and articular congruity. Osteophyte removal and anterior capsular release were performed if necessary. At the final follow-up of 54 months, pain around the humeroradial joint had resolved in all cases. Range of motion improved from 115° flexion, -39° extension, 55° pronation, and 54° supination preoperatively to 127° flexion, -27° extension, 60° pronation, and 65° supination postoperatively. The articular congruity of the humeroradial joint was well maintained at final follow-up, with the exception of 2 cases in which the space decreased after 4 years. Arthroscopic partial excision of the radial head is a promising procedure for improvement of humeroradial symptoms. This method is effective, even for advanced cases, and should be considered before total arthroplasty. [ Orthopedics . 2022;45(4):209–214.]