ARTT Approach to Total Elbow Arthroplasty Devised for Post-Trauma Patients: Preliminary Results

Background: An increasing number of total elbow arthroplasty (TEA) procedures are performed in trauma patients every year through a variety of approaches. We have devised the Anconeus-reflected Triceps tongue (ARTT) approach for TEA, which optimizes soft tissue management and implant placement, particularly in post-trauma patients, where extensive scar tissue and/or marked bone deformity hamper joint exposure and carry a risk of component malposition. We describe the ARTT surgical technique, discuss its advantages, and report its preliminary results. Methods: Six consecutive patients with malunion of the articular elbow surfaces with severe soft tissue retraction and multiple previous surgeries underwent TEA using the ARTT approach, which spares the triceps tendon insertion on the olecranon and reflects the anconeus and triceps muscles as one. Results: At a mean follow-up of 29 months, the Mayo Elbow Performance Score had increased from 39 to 95 points, whereas the visual analog score for pain had fallen from 7.5 to 1. None of the patients had insufficiency or secondary detachment of the triceps tendon and all achieved grade 4 or 5 on the Medical Research Council scale. Discussion: The ARTT approach provides enhanced joint exposure, resulting in the preservation of the triceps tendon insertion on the olecranon and enabling earlier active rehabilitation. Our preliminary results indicate that it is a viable alternative to traditional techniques, particularly in post-trauma patients with severe elbow dysfunction, who often suffer from extensive scarring, soft tissue damage, and bone deformity.