Performed by – Gareth Hill, Philip Rosell Ankit Desai

OK procedure
The Outerbridge and Kashiwagi procedure (usually shortened to OK) is a technique used to improve pain and movement in a stiff elbow or to remove loose bits of bone from inside the joint.

When is it performed?
A patient may complain of reduced movement or locking of the elbow. This may be painful and may be related to a background of an injury in the past. Loose bits of bone may be moving inside the joint and they will intermittently become stuck limiting movement. The joint may also have some elements of arthritis and spurs of bone can catch at the back of the joint over the tip of the elbow known as the olecranon.

How is it performed?
It is usually performed under a general anaesthetic using a tourniquet on the arm. The operation takes around 45 minutes to perform. A short incision is made at the back of the elbow and the triceps muscle is split lengthways to gain access to the olecranon. Any loose bone can be removed directly from the back of the joint at this stage. The olecranon tip is then exposed and any spurs of bone caused by arthritis are removed. This should restore the ability of the elbow to straighten. A small hole is then made directly through a thin plate of bone in the lower end of the humerus. Through this hole, access is available to the front of the joint and loose bone can usually be removed through this hole.

The bone that is removed to make this window through the joint is not load bearing and there is no major risk of fracturing the humerus by making a hole at this point. The joint is then washed out to remove any small debris and the triceps muscle is repaired before the skin is closed using absorbable sutures. After surgery you will use a sling for 1 or 2 weeks only for comfort and you will be encouraged to mobilise early with a physiotherapist.

Depending on your imaging and surgeon preference, a keyhole procedure may be added to this as this can allow further examination of the joint and removal of bony spurs. The thickened joint capsule can also be released if required. This may be added as part of an OK procedure, or as an operation alone if felt appropriate.

Outcome
This operation is generally successful with high levels of patient satisfaction and improvements in movement. However, in more arthritic joints the movement may improve but the pain may still be present and further, more major surgery may be required such as joint replacement.