Komplikationsmanagement – Ellenbogenarthrolyse

Background: Arthrolysis of the elbow is mostly a revision surgery and is therefore subject to a higher potential risk of complications. The reasons for this are primarily modified anatomical conditions due to nerve transposition, altered joint position, osteophytes and limited range of motion, particularly due to soft tissue adhesions. The reasons for soft tissue alterations could mostly be traced back to scar tissue in the region of the elbow and/or low-grade infections. Preparation: In order to avoid complications an extensive anamnesis, a detailed clinical examination including instability testing as well as up to date images and if required a neurological assessment are necessary. Complication management: The management of complications after elbow arthrolysis consists particularly of prevention of reoccurrence of stiffness due to insufficient operative radicalness (e.g. capsule incision instead of capsule excision) and inadequate postoperative physiotherapeutic follow-up treatment, a delayed onset ulnar nerve neuropathy (DOUN) due to insufficient exposure and decompression of the ulnar nerve, an infection due to long operating times and too extensive access approaches, an iatrogenic instability due to injury of the collateral ligaments and resection of heterotopic ossifications (HTO) without accompanying ossification prophylaxis or irradiation. Conclusion: The complications to be expected after arthrolysis are higher compared to the primary surgery. Generally speaking, the more invasive the type of arthrolysis, the higher is the expected rate of complications. The management of complications of arthrolysis of the elbow consists of a meticulous anamnesis, diagnostics and operative treatment as well as the preoperative planning of the follow-up treatment.