To better understand the complication risks after elbow arthroscopy, in the study“Complication of Elbow Arthroscopy in a Community-Based Practice,” researchers analyzed outcomes at a large community practice with multiple surgeons.
Diabetes Is Risk Factor for Infection After Elbow Arthroscopy
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Secondary#diabetes#elbowarthroplasty#heterotopicossification
The findings which were published in the May 2020 issue of Arthroscopy suggest that overall the complication is low; however, diabetes is a risk factor for infection.
Elbow arthroscopy is used to treat a variety of condition like arthritis, symptomatic loose body removal, elbow contracture, valgus extension overload, impingement, osteochondritis dessicans and lateral epicondylitis.
Included in the study were 560 consecutive elbow arthroscopies in 528 patients performed between 2006 and 2014 by 42 surgeons at 14 facilities. The majority of patients were male and the average length of follow-up was 375.8 days.
According to the data collected, heterotopic ossification occurred in 14 cases and 20 patients developed transient nerve palsies (8 ulnar, 8 radial, 1 median, 3 medial antebrachial cutaneous).
There were 3 deep and 11 superficial infections; however, no vascular injuries, compartment syndrome, deep vein thrombosis or pulmonary embolism.
Patients with elevated blood sugar had a higher risk of infection (odds ratio [OR] 4.11, 95% confidence interval [CI] 1.337 to 12.645; p = .0136). In addition, female patients and those who had previous elbow surgery had higher risk for nerve injury.
“Heterotopic ossification may be an underreported complication of elbow arthroscopy. In this series, 2.55 of cases developed postoperative heterotopic ossification, with 1.65 of the cases requiring repeat surgical procedures as a result of the heterotopic ossification. All cases occurred in male patients, but no other significant risk factors were identified,” the researchers wrote.
“The strengths of this study include the large number of cases and contributing surgeons which helps provide a realistic analysis of postoperative complications that can be applicable to many community orthopaedic surgeons. The inclusion of surgeries with both an arthroscopic and concomitant open component increases the applicability of the results and aids with preoperative patient counseling.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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