Modified triceps fascial tongue approach for primary total elbow arthroplasty

Triceps weakness is a common complication of total elbow arthroplasty (TEA). Many posterior approaches for TEA have been introduced to maintain triceps function. The present study evaluated the clinical outcomes and extensor strengths of primary TEA with modified triceps fascial tongue approach.

Twenty-one primary TEAs performed in 20 patients by a single surgeon were reviewed with a mean of 64.2 months (range, 24-127 months) of follow-up. Every TEA was performed using the modified triceps fascial tongue approach, with the Coonrad-Morrey prosthesis. Patient demographics, range of motion, pain visual analog scale, and triceps strength (Medical Research Council [MRC] scale) were compared before and after the operation. The Mayo Elbow Performance Score was evaluated at the latest follow-up.

Triceps strength was normal (MRC grade V) in 10 elbows (48%) and good (MRC grade IV) in 11 (52%). Triceps strength after arthroplasty was significantly improved compared with the preoperative strength (P < .001). Mean flexion arc was improved from 78° to 100° after arthroplasty (P = .004). However, mean flexion contracture (preoperative; 29°, postoperative; 26°) was not improved after surgery (P = .377). The mean visual analog scale pain score improved from 7.7 preoperatively to 2.4 postoperatively (P < .001). Postoperative Mayo Elbow Performance Scores were excellent in 13 elbows, good in 6, and fair in 2. The only complications were 3 intraoperative condylar fractures.

Modified triceps fascial tongue approach is an easy and effective approach for primary TEA.