Review Question - QID 217374

Deep infection is rare after elbow arthroscopy, but it is thought that the infection rate is higher if an intra-articular steroid injection is performed as an adjunct at the time of surgery.

Elbow arthroscopy is a valuable tool given its complete intra-articular visualization, versatility, and relatively quick post-operative recovery. Its indications remain somewhat narrow, but it can be useful for loose body removal, debridement, synovectomy, OCD drilling, capsular releases, and debridement of lateral epicondylitis. The primary risk associated with elbow arthroscopy is damage to neurovascular structures, namely the ulnar, radial, median, and associated sensory nerves. Though rare, deep joint infection can occur after elbow arthroscopy, and the risk of infection is believed to be higher in cases where an intra-articular steroid injection is given at the time of surgery. Therefore, this practice should be avoided by current standards.

Kelly et al. reviewed the complications of elbow arthroscopy in 473 consecutive cases, noting that minor complications occurred in 11% and major complications in 0.8%. Prolonged drainage and/or superficial infection occurred in 7% but were ultimately deemed minor in all cases.

Baker et al. reviewed the indications, anatomy, and techniques involving elbow arthroscopy. They reviewed, in detail, the approach and anatomy of each separate portal and the possible neurovascular dangers associated. Finally, they summarized the common complications, including nerve injury, excessive drainage, stiffness, and wound infection, and concluded that, despite these risks, elbow arthroscopy served as a unique and valuable tool for the management of a variety of elbow conditions.

Camp et al. explored factors which increased the risk of infection after elbow arthroscopy. They found that 1.55% of the cohort developed an infection postoperatively and the most common risk factors were age >65 (OR 2.38), BMI > 40 (OR 1.97), tobacco usage (OR 1.8), alcohol usage (OR 4.01), diabetes (OR 2.10), inflammatory arthritis (OR 2.81), hypercoagulable disorder (OR 2.51), and intra-articular steroid injection at the time of surgery (OR 2.79). They conclude that steroid injections should not be given at the time of surgery, as this is one of the primary modifiable risk factors.

Figure A is a lateral elbow radiograph demonstrating arthritic changes with a large anterior loose body.

Incorrect Answers:
Answer 1: Posterior midline portal use does not increase the rate of infection.
Answer 3: Osteoarthritis is not a contraindication to elbow arthroscopy and does not increase the risk of infection if chosen as the treatment. Contrarily, there has been some suggestion of an increased risk of infection in patients with inflammatory arthritis.
Answer 4: Portals can be closed with absorbable or non-absorbable sutures, with no difference in infection risk.
Answer 5: Restriction of elbow range of motion postoperatively does not decrease infection rates and may risk increased elbow stiffness.