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Postoperative Care

Elbow postoperative care: pain management, rehabilitation, wound care, and complication mitigation post-arthroscopy to arthroplasty.

Overview

Pre-operative soft tissue injuries are independent predictors of elbow stiffness after radial head fracture fixation [3]. The overall rate of short-term complications requiring inpatient treatment following total elbow arthroplasty is over 10% [4], with almost 8% of patients requiring reoperation within the first 90 days [4]. For elbow arthroscopy, the incidence of 30-day postoperative adverse events is 1.89%, and the need to return to the operating room is 0.94% [9].

Postoperative pain control should begin before surgery [5]. Combining multiple strategies for pain treatment is beneficial for postoperative pain management [5], and multimodal analgesia decreases opioid consumption after shoulder arthroplasty without increasing short-term complications or unplanned readmissions [8]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [6]. Optimization of postoperative care after rotator cuff repair is needed, particularly regarding pain management and patient selection [28].

There is no difference in complications and outcomes between outpatient settings for shoulder arthroplasty [19]. Routine early postoperative radiographs after implant removal in pediatric patients are overutilized and do not provide clinical benefit for most patients [11], rarely changing postoperative management [11]. Subjective and objective outcomes of revision surgery for cubital tunnel syndrome are inferior to outcomes of similar patients following primary surgery [10].

Anatomy & Pathophysiology

Elbow contracture is challenging to treat, making prevention of paramount importance [12]. A thorough understanding of the 3-dimensional anatomy of the elbow and surrounding nerves is required to avoid neurologic complications [45].

Osseous & Operative Risk: Orthogonal plate configuration, olecranon osteotomy, and longer operative time are associated with increased odds of dysfunctional elbow stiffness following operative fixation of distal humerus fractures [56].

Kinematics: Both elbow varus torque and swing velocity are greatest when swinging to the outside location [43].

Rehabilitation: Structured preoperative rehabilitation protocols downgrade the severity of elbow stiffness [61].

Classification

Gustilo–Anderson: The fracture type defined by this classification is the factor most strongly associated with the development of deep infection and nonunion in open fractures of the radius and/or ulna [73].

Other Considerations: Depressive symptoms during the rehabilitation period predict poor outcomes of lumbar spinal stenosis surgery [1]. Pre-operative soft tissue injuries are independent predictors of elbow stiffness after radial head fracture fixation [3]. The overall rate of short-term complications requiring inpatient treatment following total elbow arthroplasty is high, at over 10% [4]. Almost 8% of total elbow arthroplasty patients require reoperation within the first 90 days [4]. The incidence of 30-day postoperative adverse events following elbow arthroscopy is 1.89% [9]. The need to return to the operating room following elbow arthroscopy within 30 days is 0.94% [9]. Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty, with a rate of 0.2% [2]. Rehabilitation for patients undergoing first-time lumbar discectomy is delivered most frequently postoperatively, with one in three centers providing it preoperatively [16]. Most differences in surgical morbidity between cubital tunnel surgeries are transient, with resolution after 8 weeks following surgery [33]. Surgical release and rehabilitation for post-traumatic elbow stiffness do not differ regarding clinical scores [65]. Surgical release and rehabilitation for post-traumatic elbow stiffness do not differ regarding complication rates [65]. The development of a consensus definition of periprosthetic shoulder infection is critical for future investigations [66]. Current evidence suggests that some types of hand surgery may be performed outside the operating theatre without increasing the risk of infection, although the evidence quality is poor [67].

Clinical Presentation

Predictors of Outcome: Pre-operative soft tissue injuries independently predict elbow stiffness after radial head fracture fixation [3]. Depressive symptoms during the rehabilitation period predict poor outcomes of lumbar spinal stenosis surgery [1]. Patients undergoing total knee replacement with preoperative strengthening plus balance training are expected to present similar performance at 1 year postoperatively [24].

Pain Management and Monitoring: Postoperative pain control should begin before surgery, and combining multiple strategies for pain treatment is beneficial [5]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [6]. Patients using cold therapy units (CTUs) reported statistically lower but clinically equivocal Visual Analog Scale (VAS) scores during the first postoperative week following arthroscopic rotator cuff repair [21]. Surgeon and patient awareness and education are needed for the management of postoperative opioid usage associated with indicated conditions after elective shoulder arthroplasty [36].

Physical Examination and Imaging Findings: Subscapularis tear after total shoulder arthroplasty is a common finding that cannot be diagnosed reliably by physical examination or radiographs [22]. A postoperative drop sign of the elbow joint was observed in 17% of patients after surgical stabilization of an unstable simple posterolateral dislocation and spontaneously disappeared within 1 week in all cases [17]. Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty, with radiology reports identifying postoperative complications in 0.2% of cases [2]. Routine early postoperative radiographs after implant removal in pediatric patients are overutilized and rarely change postoperative management [11].

Complications and Red Flags: Infection after shoulder surgery is rare but potentially devastating, requiring perioperative measures to prevent infection and clinical acumen for diagnosis [35]. Timely and accurate diagnosis and optimal management are paramount to prevent loss of function and other devastating sequelae of infection in the knee joint after anterior cruciate ligament reconstruction [23]. Surgery for chronic elbow dislocations using hinged external fixation can be associated with a high risk of complications, potential treatment failure, and a need for additional surgical procedures [20]. Inpatient admission following anterior cruciate ligament reconstruction is associated with higher postoperative complications [18].

Investigations

Plain radiography: Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty, with radiology reports identifying postoperative complications in only 0.2% of cases [2]. Routine early postoperative radiographs after implant removal in pediatric patients are overutilized and rarely change postoperative management [11]. Subscapularis tears after total shoulder arthroplasty are a common finding that cannot be diagnosed reliably by physical examination or radiographs [22].

MRI: Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [80].

Other Considerations: Depressive symptoms during the rehabilitation period predict poor outcomes of lumbar spinal stenosis surgery [1]. Pre-operative soft tissue injuries are independent predictors of elbow stiffness after radial head fracture fixation [3]. Patient-reported outcome measures (PROMs) exhibit marked and consistent improvement from preoperative to final postoperative follow-up after total elbow arthroplasty [7]. Subjective and objective outcomes for revision surgery for cubital tunnel syndrome are inferior to outcomes for similar patients following primary surgery [10]. Postoperative functional outcomes after open arthrolysis for post-traumatic elbow stiffness are inferior in overweight patients compared to normal weight patients [15]. Physical therapy for lumbar discectomy is delivered most frequently postoperatively, with one in three centers providing it preoperatively [16]. A postoperative drop sign of the elbow joint after surgical stabilization of an unstable simple posterolateral dislocation was observed in 17% of patients and spontaneously disappeared within 1 week in all cases [17]. The use of cold therapy units (CTUs) in the postoperative period results in statistically lower but clinically equivocal visual analog scale (VAS) pain scores during the first postoperative week following arthroscopic rotator cuff repair [21]. Timely and accurate diagnosis of infections after anterior cruciate ligament reconstruction (ACL-R) is paramount to prevent loss of function and other devastating sequelae [23]. Preoperative strengthening plus balance training results in similar balance and functional performance at 1 year postoperatively following total knee replacement [24]. Complications, including reoperation, are frequent after semiconstrained total elbow arthroplasty for ankylosed and stiff elbows, though the risk can be lessened by careful preoperative planning and surgical technique [30]. Two-stage revisions with articulating antibiotic spacers after failed and infected elbow surgery have a high complication rate (25%), although functional and radiographic results are satisfying after a mean follow-up of 5 years [78]. The long-term durability of arthroscopic ulnohumeral arthroplasty for degenerative arthritis of the elbow in patients under fifty years of age regarding preservation of range of motion and radiographic progression of arthritis remains unknown [82]. Elbow contracture is challenging to treat, making prevention of elbow stiffness paramount [12].

Treatment

Non-Operative

Non-operative management remains a viable option for select patient populations. Nonoperative management of displaced olecranon fractures in elderly and medically unwell patients can result in reasonable range of motion, minimal pain, and maintenance of extension against gravity [76]. Similarly, nonoperative management of distal humerus fractures in the elderly yields acceptable functional outcomes and low rates of delayed surgery [64]. For lateral epicondylosis, most patients experience relief with non-operative management, though controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases [52]. Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care [37]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [71].

Operative

Indications: Surgical intervention is indicated for specific deformities and failed conservative care. Surgery for coxa vara in childhood is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery [74]. Open surgical release for contractures of the elbow can yield sustained improvement of range of motion and patient quality of life in the setting of failed nonsurgical treatment [69]. Custom hemiarthroplasty is a reasonable method to salvage proximal humeral dysplasia epiphysealis hemimelica when nonsurgical management has failed [70]. Megaprosthetic replacement for complex distal humerus fractures in elderly patients is a salvage procedure that requires narrowed indications, as failure causes more complex situations [25].

Surgical Approach / Technique: Surgery for chronic elbow dislocations using hinged external fixation is associated with a high risk of complications, potential treatment failure, and a need for additional surgical procedures [20]. Postoperative functional outcomes after open arthrolysis for post-traumatic elbow stiffness are inferior in the overweight group compared to the normal weight group [15]. Pre-operative soft tissue injuries are independent predictors of elbow stiffness after radial head fracture fixation [3]. Elbow contracture is challenging to treat, making prevention of paramount importance [12]. Continuous postoperative catheter irrigation is not necessary for the treatment of suppurative flexor tenosynovitis, as there are no statistically significant differences in outcomes compared to intraoperative irrigation only [26].

Pain Management: Postoperative pain control should begin before surgery and combining multiple strategies for pain treatment is beneficial [5]. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications [6]. Multimodal analgesia decreases opioid consumption after shoulder arthroplasty without increasing short-term complications or unplanned readmissions [8]. Interscalene block combined with multimodal pain control is an effective and safe method for providing postoperative analgesia after arthroscopic rotator cuff repair [50]. Preoperative opioid use does not significantly affect postoperative outcomes or opioid use after arthroscopic rotator cuff repair, as all patients demonstrate significant improvements in outcomes scores [59]. Patient perceptions regarding pain control after shoulder surgery highlight the need for better counseling and innovative nonopioid pain management protocols [75]. Optimization of postoperative care after rotator cuff repair is needed, particularly regarding pain management and patient selection [28].

Setting of Care: An enhanced recovery after surgery (ERAS) protocol for open reduction of distal humerus fractures in children ameliorates preoperative discomfort and postoperative pain, shortens postoperative hospital stay, accelerates postoperative functional recovery, and does not increase the risks of postoperative nausea, vomiting, or poor incision healing [46].

Other Considerations: Depressive symptoms during the rehabilitation period predict poor outcomes of lumbar spinal stenosis surgery, warranting further clinical evaluation especially during postoperative stages [1]. The overall rate of short-term complications requiring inpatient treatment following total elbow arthroplasty is high, at over 10%, with almost 8% requiring reoperation within the first 90 days [4]. The incidence of 30-day postoperative adverse events following elbow arthroscopy is 1.89%, with a need to return to the operating room in 0.94% of cases [9]. Total elbow arthroplasty offers satisfactory clinical outcomes at long-term follow-up, with relatively stable revision and complication rates compared to short and medium term [13]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is critical for their utilization [42].

Complications

General Risk Factors and Predictors: Patient demographics, medical comorbidities, and surgical factors predict short-term complications following distal biceps tendon repair [29]. In anterior cruciate ligament reconstruction, inpatient admission is associated with higher postoperative complications [18]. For arthroscopic shoulder surgery, risks within 30 days increase with age older than 60 years, surgical time greater than 90 minutes, chronic obstructive pulmonary disease (COPD), inpatient status, disseminated cancer, and current smoking [31]. Evaluating operative time as a cause of adverse events is difficult due to potential unmeasured confounders and lack of orthopedic-specific outcome data [32].

Shoulder Arthroplasty: Routine immediate postoperative radiographs rarely identify unknown complications, with a rate of 0.2% [2]. Multimodal analgesia does not increase short-term complications or unplanned readmissions [8].

Elbow Arthroplasty: The overall rate of short-term complications requiring inpatient treatment following total elbow arthroplasty is high, at over 10% [4]. Almost 8% of patients require reoperation within the first 90 days [4]. Diabetic patients have significantly higher rates of several perioperative complications, and diabetes is an independent risk factor for prolonged hospital stay and increased risk of nonhomebound discharge [77]. Complications, including reoperation, are frequent after semiconstrained total elbow arthroplasty for ankylosed and stiff elbows, but risk can be lessened by careful preoperative planning and surgical technique [30]. Total elbow arthroplasty offers satisfactory clinical outcomes at long-term follow-up with relatively stable revision and complication rates compared to short and medium term [13].

Elbow Arthroscopy: The incidence of 30-day postoperative adverse events is 1.89%, and the need to return to the operating room within 30 days is 0.94% [9]. Ultrasound-guided tenotomy for tendinopathies of the elbow has no reported complications in long-term follow-up [49].

Distal Radius Fractures: Time to surgery did not affect infection, complication, or readmission rates in type I open distal radius fractures surgically treated more than 24 hours post-injury [62].

Rehabilitation and Outcomes: A thorough well-designed postoperative or postinjury rehabilitation program may prevent most complications [68]. Depressive symptoms during the rehabilitation period predict poor outcomes of lumbar spinal stenosis surgery [1].

Other Considerations: Ulnar collateral ligament reconstruction demonstrates low complication and revision rates at medium-term follow-up [27].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity, desk work, or driving. However, most differences in surgical morbidity following cubital tunnel surgeries are transient with resolution after 8 weeks [33]. For distal biceps repair, sensory neurapraxia is not associated with patient-reported outcomes or satisfaction, and patient and surgical characteristics do not influence the occurrence or time to resolution of neurapraxia [83].

Full activity (months): Evidence does not provide specific month ranges for manual work, sport, or full ROM/strength return. Long-term results are needed to assess the survivorship of cementless total elbow arthroplasty using the Discovery elbow system [57]. Further studies with long-term follow-up are needed to determine if the grafted area maintains structural and functional integrity after Autologous Matrix-Induced Chondrogenesis for focal cartilage defects in the knee [53].

Complete recovery / outcome plateau (months): Evidence does not provide specific month ranges for when pain, strength, and final functional outcomes stabilise. Total elbow arthroplasty offers satisfactory clinical outcomes at long-term follow-up, with relatively stable revision and complication rates compared to short and medium term [13]. The Discovery Elbow System results in improved function, reduced pain, and high patient satisfaction at a 4-year mean follow-up [14]. Patients with juvenile idiopathic arthritis benefit from total elbow arthroplasty for a long term with satisfactory clinical outcomes and implant durability [60].

Rehabilitation protocol: Evidence does not specify PT phasing, immobilisation duration, weight-bearing/ROM progression, or sling/brace removal timing. The conventional surgical delay of more than 1 year for excision of heterotopic ossification of post-traumatic stiff elbow may be shortened [79].

Functional milestones: Patient-reported outcome measures (PROMs) for total elbow arthroplasty exhibit marked and consistent improvement from preoperative to final postoperative follow-up [7]. Ulnar collateral ligament reconstruction (UCLR) provides excellent patient-reported and clinical outcomes at medium-term follow-up with low complication and revision rates [27]. Postoperative functional outcomes for open arthrolysis for post-traumatic elbow stiffness are inferior in the overweight group compared to the normal weight group [15].

Other Considerations: Depressive symptoms during the rehabilitation period predict poor outcome of lumbar spinal stenosis surgery [1]. Multimodal analgesia decreases opioid consumption after shoulder arthroplasty without increasing short-term complications or unplanned readmissions [8]. The study design regarding single shot interscalene regional anesthesia does not allow for conclusions regarding length of stay, range of motion, or eventual patient outcome based on early pain scores [81].

Predictors of short-term complications vary by procedure. For total elbow arthroplasty, the overall rate of short-term complications requiring inpatient treatment is high, at over 10%, and almost 8% of patients require reoperation within the first 90 days [4]. For distal biceps tendon repair, patient demographics, medical comorbidities, and surgical factors are predictive of short-term complications [29]. For arthroscopic shoulder surgery, age older than 60 years, surgical time greater than 90 minutes, COPD, inpatient status, disseminated cancer, and current smoking increase the risk of complications within 30 days [31]. Evaluating operative time as a cause of adverse events is difficult due to potential unmeasured confounders and lack of orthopedic-specific outcome data [32].

Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty, with a rate of 0.2% [2]. The risk profile of carefully selected patients undergoing same-day discharge after total elbow arthroplasty is acceptable when combined with close follow-up [84].

Key Evidence

  • [L2] For these patients, further clinical evaluation should be carried out, especially during postoperative stages. (10.1186/1471-2474-11-152)
  • [L4] The radiology reports of routine immediate postoperative radiographs rarely identified postoperative complications (0.2%). (10.1016/j.jse.2022.10.027)
  • [L3] These findings justify the need for a large, multicenter trial to confirm these associations and establish evidence-based post-operative guidelines. (10.1016/j.jseint.2026.101652)
  • [L4] The overall rate of short-term complications requiring inpatient treatment was high, at over 10%, with almost 8% requiring reoperation within the first 90 days. (10.1016/j.jhsa.2010.09.036)
  • [L3] The evidence available suggests that postoperative pain control should begin before surgery and that combining multiple strategies for pain treatment is beneficial. (10.1016/j.jhsa.2015.05.024)
  • [L4] The exclusive use of pain scores in postoperative pain management should be limited to prevent complications. (10.1016/j.arthro.2006.11.002)
  • [L4] PROMs overall exhibited marked and consistent improvement from preoperative to final postoperative follow-up. (10.1016/j.jse.2024.02.017)
  • [L2] There is no increase in short-term complications or unplanned readmissions, indicating that this is a safe and effective means to control postoperative pain. (10.1016/j.jse.2017.11.015)
  • [L4] Overall, the incidence of 30-day postoperative adverse events (1.89%) and need to return to the OR (0.94%) is low. (10.1016/j.arthro.2017.08.286)
  • [L3] Subjective and objective outcomes of revision patients in this cohort were inferior to outcomes of similar patients following primary surgery. (10.1016/j.jhsa.2014.07.013)
  • [L3] Routine early postoperative radiographs after implant removal are overutilized and do not provide clinical benefit for most pediatric patients, as they rarely change postoperative management. (10.5435/jaaos-d-22-00883)
  • [L5] Elbow contracture is challenging to treat, and therefore prevention is of paramount importance. (10.1016/j.jhsa.2009.02.020)
  • [L4] Our systematic review established that TEA offers patients satisfactory clinical outcomes at long-term follow-up, with relatively stable revision and complication rates compared to short and medium term. (10.1016/j.jse.2020.11.014)
  • [L4] The Discovery Elbow System resulted in improved function, reduced pain, and high patient satisfaction. (10.1016/j.jse.2014.08.013)
  • [L3] The postoperative functional outcomes of the overweight group were inferior to those of the normal weight group to a certain extent. (10.1016/j.jse.2016.12.065)
  • [L4] Rehabilitation was delivered most frequently postoperatively, with one in three centers providing it preoperatively. (10.1186/s12891-022-05346-1)
  • [L4] A postoperative drop sign was observed in 17% of patients and spontaneously disappeared within 1 week in all cases; it did not indicate the need for additional stabilization nor affect functional outcomes. (10.1016/j.jse.2015.01.018)
  • [L3] Although some patients may require admission post-operatively for medical and/or pain management, doing so is not necessarily without a degree of risk. (10.1007/s00167-020-06094-2)
  • [L4] No difference in complications and outcomes occurs regardless of outpatient setting. (10.1016/j.jse.2019.04.006)
  • [L4] Patients should be aware that surgery can be associated with a high risk of complications, potential treatment failure, and a need for additional surgical procedures. (10.1016/j.jhsa.2014.12.043)
  • [L3] Patients who used CTUs reported statistically lower but clinically equivocal VAS scores during the first postoperative week, while patient-reported functional outcomes were not affected by CTU use. (10.1016/j.jse.2025.08.026)
  • [L4] Subscapularis tear after total shoulder arthroplasty is a common finding that cannot be diagnosed reliably by physical examination or radiographs. (10.1016/j.jse.2010.04.001)
  • [L5] These recommendations guide clinicians in achieving timely and accurate diagnosis as well as providing optimal management, both of which are paramount to prevent loss of function and other devastating sequelae of infection in the knee joint. (10.1007/s00167-023-07463-3)
  • [L2] Patients are expected to present similar performance at 1 year postoperatively. (10.1007/s00167-020-06029-x)
  • [L4] The indication for this type of treatment must be selected and narrowed down, as it is a salvage procedure, and any failure would cause even more complex situations. (10.1186/s13018-023-04465-2)
  • [L3] There were no statistically significant differences in outcomes between patients receiving intraoperative irrigation only and those receiving continuous postoperative irrigation. (10.1054/jhsb.2000.0400)
  • [L4] UCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. (10.1136/jisakos-2021-000614)
  • [Commentary] Optimization of postoperative care after rotator cuff repair is needed, particularly regarding pain management and patient selection. (10.1016/j.arthro.2019.01.014)
  • [L3] Various patient demographics, medical comorbidities, and surgical factors were all predictive of short-term complications. (10.5397/cise.2021.00472)
  • [L4] Because of the nature of the underlying pathology, complications, including reoperation, are frequent, but the risk can be lessened by careful preoperative planning and surgical technique. (10.2106/00004623-200009000-00006)
  • [L4] Age older than 60 years, surgical time greater than 90 minutes, COPD, inpatient status, disseminated cancer, and current smoking all increased a patient's risk of complications. (10.1016/j.arthro.2014.12.011)
  • [L5] Evaluating operative time as a cause of adverse events is difficult due to potential unmeasured confounders and lack of orthopedic-specific outcome data; additional research is needed to better clarify the causality of observed associations. (10.1016/j.arth.2018.04.029)
  • [L2] However, most differences in surgical morbidity are transient with resolution after 8 weeks following surgery. (10.1016/j.jhsa.2017.10.033)
  • [L5] Infection after shoulder surgery is rare but potentially devastating; perioperative measures to prevent infection are of paramount importance, and clinical acumen is necessary for diagnosis. (10.5435/00124635-201104000-00005)
  • [L3] These findings emphasize the need for surgeon and patient awareness as well as education in the management of postoperative opioid usage associated with the indicated conditions. (10.1016/j.jse.2018.04.018)
  • [Paper] Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care. (10.1016/j.csm.2014.01.001)
  • [L5] Additionally, both elbow varus torque and swing velocity were greatest when swinging to the outside location. (10.1016/j.jse.2025.02.001)
  • [L4] A thorough understanding of the 3-dimensional anatomy of the elbow and surrounding nerves is needed to avoid neurologic complications. (10.1016/j.jse.2015.07.033)
  • [L1] The ERAS protocol can ameliorate preoperative discomfort and postoperative pain, shorten the postoperative hospital stay, and accelerate postoperative functional recovery without increasing the risks of postoperative nausea, vomiting, and poor incision healing. (10.1186/s12891-022-05675-1)
  • [L4] These effects have been sustained in long-term follow-up with no reported complications. (10.1016/j.jse.2019.06.011)
  • [L2] It is an effective and safe method for providing postoperative analgesia after arthroscopic rotator cuff repair. (10.1007/s00167-012-2272-3)
  • [L5] This article serves to provide an updated review of the various treatment options and management for lateral epicondylosis, noting that while most patients experience relief with non-operative management, controversy remains regarding the optimal modality for quickest recovery and the role of surgical intervention for refractory cases. (10.1016/j.jhsa.2024.07.003)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L3] Orthogonal plate configuration, olecranon osteotomy, and longer operative time were associated with increased odds of dysfunctional elbow stiffness. (10.1016/j.jse.2024.06.010)
  • [L4] Long-term results are needed to assess the survivorship of this design. (10.1016/j.jse.2017.03.025)
  • [L3] All patients demonstrated significant improvements in outcomes scores after surgical repair that were not significantly different between groups. (10.1016/j.jse.2018.08.036)
  • [L4] However, most benefit from the intervention for a long term with satisfactory clinical outcomes and implant durability. (10.1016/j.jse.2014.03.012)
  • [L4] Structured preoperative rehabilitation protocol downgrades the severity of elbow stiffness. (10.1016/j.jse.2025.02.042)
  • [L3] Time to surgery did not affect infection, complication, or readmission rates. (10.1177/15589447221131849)
  • [L4] Nonoperative management of distal humerus fractures in the elderly seems to be associated with acceptable functional outcomes and low rates of delayed surgery. (10.1016/j.xrrt.2021.10.001)
  • [L1] The groups did not differ regarding clinical scores and complication rates. (10.1016/j.jse.2020.03.023)
  • [L5] The development of a consensus definition of a periprosthetic shoulder infection is critical to future investigations of these devastating complications. (10.2106/jbjs.m.00402)
  • [L4] Although the current evidence is of poor quality, it suggests that some types of hand surgery may be done outside the operating theatre without increasing the risk of infection. (10.1177/1753193416676408)
  • [Paper] A thorough well-designed postoperative or postinjury rehabilitation program may prevent most complications, and if complications do arise, a team approach working to develop an evidenced-based treatment program designed specifically for the underlying complication can successfully treat these issues. (10.1016/j.csm.2017.12.010)
  • [L5] In the setting of failed nonsurgical treatment of the stiff elbow, surgical release can yield sustained improvement of ROM and patient quality of life. (10.5435/jaaos-d-14-00051)
  • [Case_report] This appears to be a reasonable method to salvage this difficult and challenging problem when nonsurgical management has failed to provide relief. (10.1016/j.jse.2011.08.043)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L5] Having an established pain management system in place with protocols to assist not only in reducing opioids but also in improving a framework for managing the perioperative period is imperative. (10.1016/j.arth.2020.01.001)
  • [L3] The type of fracture as outlined by the Gustilo-Anderson classification was the factor most strongly associated with the development of deep infection and nonunion in these fractures. (10.1016/j.jhsa.2014.02.008)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L4] This highlights the need for better counseling and innovative nonopioid pain management protocols. (10.1016/j.jseint.2020.12.019)
  • [L4] Displaced olecranon fractures in elderly and medically unwell patients treated nonoperatively can result in reasonable range of motion, minimal pain, and maintenance of extension against gravity. (10.1016/j.jseint.2020.11.001)
  • [L3] Diabetic patients have significantly higher rates of several perioperative complications, and diabetes is an independent risk factor for prolonged hospital stay, as well as increased risk of nonhomebound discharge. (10.1016/j.jse.2014.10.008)
  • [L3] Functional and radiographic results are satisfying after a mean FU of 5 years, although the complication rate is high (25%). (10.1016/j.jse.2021.03.125)
  • [L3] The conventional surgical delay of more than 1 year may be shortened. (10.1016/j.jse.2015.05.044)
  • [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
  • [Letter] The study design does not allow for conclusions regarding factors such as length of stay, range of motion, or eventual patient outcome based on early pain scores; further study is needed on the effect of early postoperative pain and block-related complications on eventual patient outcome. (10.1016/j.jse.2022.05.007)
  • [L4] The long-term durability of this procedure with regard to preservation of ROM and radiographic progression of arthritis remains unknown. (10.1016/j.jse.2006.09.001)
  • [L3] Patient and surgical characteristics did not influence the occurrence or time to resolution of neurapraxia. (10.1016/j.jse.2024.05.059)
  • [L4] The risk profile of carefully selected patients undergoing same-day discharge after TEA is acceptable when combined with close follow-up. (10.1016/j.jse.2018.03.019)

See Also

References

[1] Depressive symptoms during rehabilitation period predict poor outcome of lumbar spinal stenosis surgery: A two-year perspective. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-152

[2] Routine immediate postoperative radiographs rarely identify unknown complications after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.10.027

[3] Pre-operative soft tissue injuries as independent predictors of elbow stiffness after radial head fracture fixation: a pilot study. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101652

[4] Complication and Revision Rates Following Total Elbow Arthroplasty. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.09.036

[5] Management of Acute Postoperative Pain in Hand Surgery: A Systematic Review. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.024

[6] Pain Scores in the Management of Postoperative Pain in Shoulder Surgery. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.11.002

[7] Midterm follow-up of the Nexel total elbow arthroplasty. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.02.017

[8] Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: a prospective cohort study. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.11.015

[9] Elbow Arthroscopy: 30‐Day Postoperative Complication Profile and Associated Risk Factors. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.286

[10] Outcomes of Revision Surgery for Cubital Tunnel Syndrome. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.07.013

[11] No Value Found With Routine Early Postoperative Radiographs after Implant Removal in Pediatric Patients. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-22-00883

[12] Prevention and Treatment of Elbow Stiffness. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.02.020

[13] Long-term outcomes of total elbow arthroplasty: a systematic review of studies at 10-year follow-up. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.11.014

[14] Total elbow arthroplasty: a prospective clinical outcome study of Discovery Elbow System with a 4-year mean follow-up. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.08.013

[15] The influence of body mass index on outcome of open arthrolysis for post-traumatic elbow stiffness. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.12.065

[16] Physical therapy of patients undergoing first-time lumbar discectomy: a survey of current UK practice. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05346-1

[17] Drop sign of the elbow joint after surgical stabilization of an unstable simple posterolateral dislocation: natural course and contributing factors. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.01.018

[18] Inpatient admission following anterior cruciate ligament reconstruction is associated with higher postoperative complications. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06094-2

[19] Outpatient shoulder arthroplasty: outcomes, complications, and readmissions in 2 outpatient settings. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.04.006

[20] Complications Associated With Hinged External Fixation for Chronic Elbow Dislocations. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.043

[21] The use of cold therapy unit in the postoperative period influences pain and narcotic use following arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.08.026

[22] Integrity and function of the subscapularis after total shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.04.001

[23] ESSKA and EBJIS recommendations for the management of infections after anterior cruciate ligament reconstruction (ACL‐R): prevention, surgical treatment and rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy. 2023. DOI: 10.1007/s00167-023-07463-3

[24] A randomized controlled trial assessing the effects of preoperative strengthening plus balance training on balance and functional outcome up to 1 year following total knee replacement. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06029-x

[25] Megaprosthetic replacement in complex distal humerus fractures in elderly patients: a case series. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-023-04465-2

[26] Continuous Postoperative Catheter Irrigation is not Necessary for the Treatment of Suppurative Flexor Tenosynovitis. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0400

[27] Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2021-000614

[28] Editorial Commentary: Optimizing Postoperative Care After Rotator Cuff Repair: What Do We Know and Understand?. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019. DOI: 10.1016/j.arthro.2019.01.014

[29] Determining the incidence and risk factors for short-term complications following distal biceps tendon repair. Clinics in Shoulder and Elbow. 2022. DOI: 10.5397/cise.2021.00472

[30] Semiconstrained Total Elbow Arthroplasty for Ankylosed and Stiff Elbows. The Journal of Bone and Joint Surgery-American Volume*. 2000. DOI: 10.2106/00004623-200009000-00006

[31] An Analysis of Adult Patient Risk Factors and Complications Within 30 Days After Arthroscopic Shoulder Surgery. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2014.12.011

[32] Response to Letter to the Editor on “Impact of Operative Time on Adverse Events Following Primary Total Joint Arthroplasty”. The Journal of Arthroplasty. 2018. DOI: 10.1016/j.arth.2018.04.029

[33] Comparative Morbidity of Cubital Tunnel Surgeries: A Prospective Cohort Study. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.10.033

[35] Infection After Shoulder Surgery. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201104000-00005

[36] Risk factors for postoperative opioid use after elective shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.04.018

[37] Physical Therapy Management of Patients with Osteochondritis Dissecans. Clinics in Sports Medicine. 2014. DOI: 10.1016/j.csm.2014.01.001

[42] Chapter 3 Emerging Technologies in Orthopaedic Trauma. 2021.

[43] Medial elbow torque during baseball hitting: considerations for return to play. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.001

[45] The incidence of neurologic complications and associated risk factors in elbow surgery: an analysis of 2759 cases. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.07.033

[46] Evaluation of open reduction of distal humerus fractures in children after implementation of an enhanced recovery after surgery program. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05675-1

[49] Ultrasound-guided tenotomy improves physical function and decreases pain for tendinopathies of the elbow: a retrospective review. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.06.011

[50] Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2272-3

[52] Management of Lateral Epicondylosis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.07.003

[53] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[56] Risk factors for dysfunctional elbow stiffness following operative fixation of distal humerus fractures. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.06.010

[57] Results of cementless total elbow arthroplasty using the Discovery elbow system at a mean follow-up of 61.8 months. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.03.025

[59] Influence of preoperative opioid use on postoperative outcomes and opioid use after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.08.036

[60] The outcome of total elbow arthroplasty in juvenile idiopathic arthritis (juvenile rheumatoid arthritis) patients. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.03.012

[61] The role of preoperative factors, surgical approach, and mobilization protocol for improved surgical outcomes after open elbow arthrolysis in post-traumatic elbow stiffness: an ambispective cohort study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.042

[62] Infection Rate in Type I Open Distal Radius Fractures Surgically Treated >24 Hours Post-Injury: A Comparison Study. HAND. 2022. DOI: 10.1177/15589447221131849

[64] Nonoperative treatment of distal humerus fractures in the elderly yields satisfactory functional outcomes and low conversion to delayed surgery: a systematic review. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2021.10.001

[65] Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.03.023

[66] Diagnosis and Management of Periprosthetic Shoulder Infections. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.00402

[67] Surgical site infection after hand surgery outside the operating theatre: a systematic review. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416676408

[68] Rehabilitation. Clinics in Sports Medicine. 2018. DOI: 10.1016/j.csm.2017.12.010

[69] Open Surgical Release for Contractures of the Elbow. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00051

[70] Treatment of proximal humeral dysplasia epiphysealis hemimelica with custom hemiarthroplasty: a case report. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.08.043

[71] Current Concepts Review - Hallux Rigidus and Osteoarthrosis of the First Metatarsophalangeal Joint. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199806000-00015

[72] The Opioid-Tolerant Patient: Opioid Optimization. The Journal of Arthroplasty. 2020. DOI: 10.1016/j.arth.2020.01.001

[73] Factors Influencing Infection Rates After Open Fractures of the Radius and/or Ulna. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.008

[74] Coxa Vara in Childhood: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199803000-00003

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[76] Outcomes of nonoperative management of displaced olecranon fractures in medically unwell patients. JSES International. 2021. DOI: 10.1016/j.jseint.2020.11.001

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