Symptomatic primary elbow osteoarthritis (OA) is a common clinical disease, and the diagnosis rate of patients over 40 years old in the United States is as high as 3.5%. It is common in middle-aged men, and often seen among heavy-duty laborers such as stonemason, percussion drill user, etc., which may be related to the minor injury of humero-ulnar joint, and mainly manifest a series of symptoms such as terminal movement pain of the elbow, restricted mobility, mechanical lock, cubital tunnel syndrome, etc. At present, elbow arthroscopy has become the mainstream method for treatment of primary elbow OA due to its advantages such as wide-field vision, thorough cleaning, minimal trauma, low risk of joint stiffness, beautiful appearance, low risk of postoperative infection, and rapid recovery. The curative effects of massive domestic and foreign reports are satisfactory, which can greatly improve symptoms, mobility and function, especially the long-term clinical reports after elbow arthroscopic release surgery in which the effect has not decreased with time. Although this group of studies has achieved consistent good results, the incidence of residual symptoms is still high, which may be related to factors such as the disease progression of elbow OA, the level of arthroscopic technology, and the understanding of surgical indications. As matters stand, there are few reports on the analysis and prediction methods of residual symptoms after arthroscopy. There are many uncertain factors in the prediction of postoperative curative effect, which cannot guide and formulate individualized treatment plans.

To explore the postoperative residual symptoms of patients with primary osteoarthritis of the elbow after arthroscopic treatment and the precautionary measures.

From January 2016 to September 2018, 28 patients with primary osteoarthritis of the elbow who were admitted into our hospital underwent arthroscopic debridement and release, and their data were retrospectively analyzed. There were 26 males and 2 females, and the mean age was 51.6 years (33-74 years) . According to the symptoms of elbow joints and the results of CT angiography, the elbow OA were divided into four stages, and there were 4 cases of Stage Ⅰ, 7 cases of Stage Ⅱ, 11 cases of Stage Ⅲa, 6 cases of Stage Ⅲb and no case of Stage Ⅳ. There were 10 cases combined with ulnar neuritis. The visual analogue scale (VAS) , motion arc and Mayo elbow performance score (MEPS) were used to evaluate the postoperative function of elbow joint. The rank sum test was used to compare the data between groups with significance level α=0.05.

All patients were followed up for 6-23 months with an average of 12.5 months. At the final follow-up, the satisfaction was 88.9%, and 62% of the patients returned to their previous work. Postoperative residual symptoms were found in 78.6% (22/28 cases) of those patients, including limited activity (11 cases, 39.3%) , pain (6 cases, 21.4%) , fatigue (14 cases, 50%) , soreness (14 cases, 50%) , clicking (2 cases, 7.1%) , and numbness (3 cases, 10.7%) . The incidence of residual symptoms increased with the staging progress of elbow osteoarthritis. At the final follow-up, there were no significant differences in VAS, motion arc or MEPS improvement between groups (P>0.05) . However, the mean VAS score of patients in Stage Ⅲb was higher than that in the other three groups, and the mean MEPS score and motion arc were lower than those in other three groups (P<0.05) .

Although patients with primary osteoarthritis of the elbow can obtain satisfactory results from arthroscopic debridement and release, the postoperative residual symptoms must not be overlooked, which are possibly related to disease progression. Only careful preoperative assessment of clinical function and imaging examination and strict control of surgical indications can provide better results.