The anconeus-triceps lateral flap approach for total elbow arthroplasty in rheumatoid arthritis

The posterior approaches to the elbow are considered as to allow an excellent joint exposure for total elbow arthroplasty. One complication that is well recognized is the insufficiency of the extensor mechanism in particular with the patients with poor tendon quality as in the rheumatoid diseases. The purpose of this paper is to present a new triceps-splitting exposure for total elbow arthroplasty used in rheumatoid patients with their preliminary results.

Fifteen consecutive patients with rheumatoid disease at grades III to V of the Larsen grading scale underwent total elbow replacement using the new triceps-splitting exposure called anconeus-triceps lateral flap and it preserves the integrity of the medial proper triceps tendon. The assessments were performed with a minimum follow-up of 2 years.

The mean Mayo Elbow Performance Score increased from 24 points to 95 points at a mean follow-up of 38 months. The pain was calculated using the visual analogue score, it had a mean pre-operative value of 8.9 points and it became 0.5 points. Although elbow motion in flexion-extension and pronosupination was allowed from the day after surgery, we did not observe any insufficiency or secondary detachments of the triceps tendon reporting grade 4 to 5 according to the Medical Research Council scale.

These preliminary outcomes suggest that the decision to preserve the medial proper triceps tendon insertion allows to start an earlier active unrestricted rehabilitation programme. This new triceps management improves the surgical exposure of the olecranon surface.

Level IV.