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Outerbridge and Kashiwagi (OK) Procedure

Other popular names

Who is it used on?

Young and active people, including sportsmen.

What is it?

Although relatively uncommon, osteoarthritis of the elbow or cubarthritis causes pain and mobility loss in the joint.  A total elbow replacement may be considered in severe elbow arthritis, particularly in the elderly. However, in mild cubarthritis and in younger patients, the decision for joint replacement is often avoided because of risks of loosening on the long term. In these cases, the ulnohumeral arthroplasty or Outerbridge-Kashiwagi (OK) procedure is often performed. 

When is Outer-Kashiwagi (OK) procedure used?

The procedure is undertaken to relieve pain, reduce locking and improve mobility of the elbow joint. Although originally developed as an open technique, I perform this as an arthroscopic procedure (keyhole surgery).

Diagnosis

Diagnosis is possible from plain x-ray, however occasionally you may be referred for an MRI to determine more accurate detail.

Non-surgical treatment

A steroid injection may improve the symptoms, however this is only likely to give short term relief and more often than not, once diagnosed, I will offer you surgery. 

Surgical treatment

Surgery is carried out as a day case procedure usually either under local or general anaesthetic and takes about 15-30 minutes.

An arthroscope (small 'telescope') is introduced into the elbow joint through several small 2-3 mm incisions.  The arthroscope is used to for location positioning with grasping and deburring tools used to provide a decompressing of the distal humeral fenestration. The skin is sutured or fixed using steristrips and a bulky dressing is applied. 

Post-surgery rehabilitation

The anaesthetic will wear off after approximately 6 hours.  Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off.  The arm should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers and elbow from day 1. The dressing will be removed soon after your operation.  The wound is cleaned and redressed with a simple dressing.  Avoid forced gripping or lifting heavy objects for 2-3 weeks.  The sutures (if used) are removed at about 10 days.  You should notice an improvement in symptoms within a few weeks but the final result may take some 3-6 months.

Return to normal routine

Keep the wound dry until the stitches are out at 10 days.

Return to driving:

The hand needs to have full control of the steering wheel and left hand the gear stick.  You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.

Return to work:

Everyone has different work environments.  Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament.  You will be given advice on your own particular situation.

Risks

Overall over 95% are happy with the result. However complications can occur.

General risks (less than 1% each):

Reflex Sympathetic Dystrophy - RSD (< 1% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).

Specific risks:

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