Treatment of mild and advanced cases of Elbow OA with Arthroscopic Debridement and Intra-Articular Hyaluronic Acid

Background: Intra-articular hyaluronic acid (HA) injections have demonstrated efficacy for osteoarthritis in joints such as the hip, knee, and ankle. As few published studies exist on the subject, HA injections for elbow OA have not been proven to be effective. This study investigates the efficacy of arthroscopic debridement with/without intra-articular hyaluronic acid (HA) injections with respect to pain relief, arc of movement, and functional improvement in 24 elbows with osteoarthritis. Material and methods: 24 elbows were treated for posttraumatic (n = 11) or primary degenerative (n = 13) osteoarthritis of the elbow by arthroscopic debridement. HA (Synvisc) injection protocol was either preoperative (n = 5), postoperative (n = 5), combined pre- and post-operative (n = 5), or without HA injections (n = 9). A clinical examination and Mayo elbow performance score was conducted at an average of 15 months (range 12–18 months) post-operation. The results were statistically analysed with the Mann-Whitney, Wilcoxon, and ANOVA tests. Results: Intra-articular cartilage changes were observed to be mild fraying (n = 5), significant fraying/fibrilliation (n = 6), and significant fibrillation with areas of bare bone (n = 13). HA injections were associated with worse outcomes in patients with severe cartilage changes and exposed bone. A non-statistically significant trend toward improved outcomes in patients without exposed bone was seen when treated with HA injection. Discussion and conclusions: These results support the use of HA in combination with elbow debridement in earlier stages of osteoarthritis with intact / frayed cartilage layer, but not in advanced cases with bone in communication with the synovial cavity. There is a symptomatic benefit in earlier stages (0–2) and a symptomatic detriment associated with HA in osteoarthritic joints with later stages (3–4), in the short term. Longer term studies are required to better understand the longevity of these results. Level of evidence: II.