title: Factors affecting choice of open surgical techniques in elbow stiffness.
abstract: BACKGROUND
  We analyzed the clinical outcomes of stiff elbow open treatment to assess factors affecting the choice of surgical procedures in a consecutive series of patients followed up prospectively.
  
  
  METHODS
  Forty-one patients, mean aged 48 years, were evaluated. Elbow stiffness was caused by post-traumatic osteoarthritis in 32 patients, primary osteoarthritis in seven and rheumatoid arthritis in two. Stiffness was classified as mixed and extrinsic in 28 and 13 cases, respectively. Seventeen ulno-humeral arthroplasties (UHA), seven UHA with radiocapitellar replacement, six UHA with radial head replacement, ten total elbow replacement and one UHA with anconeus interposition were performed. Mayo Elbow Performance Score (MEPS), modified-American Shoulder and Elbow Surgeons (m-ASES) and Q-DASH scores were used for the pre- and post-operative evaluation.
  
  
  RESULTS
  Mean follow-up was 25 months. The average increase in MEPS and m-ASES was 45 and 41, respectively. The average decrease in Q-DASH and the average increase in m-ASES pain were 43 and 21, respectively. The mean increase in flection, extension, pronation and supination was 29°, 25°, 18° and 17°, respectively. All the differences were statistically significant.
  
  
  CONCLUSIONS
  Strictly customized open surgery of elbow stiffness, by taking into account the clinical value of each patient's pathoanatomical conditions, yields satisfactory functional results in majority of cases. In particular, the degree and site of elbow cartilage wear proved to be the factors affecting the choice of treatment most. Treatment should be aimed at removing the causes of pain and at recovering range of motion.
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Via Emilio Repossi 15, 00158, Rome, Italy. giannicola.giuseppe@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Giannicola
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Via Emilio Repossi 15, 00158, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bullitta
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Via Emilio Repossi 15, 00158, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Polimanti
authors.affiliation: Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Via Emilio Repossi 15, 00158, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gumina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Elbow arthroplasty; Elbow stiffness; Osteoarthritis; Radial head replacement; Radiocapitellar replacement; Total elbow replacement