Current outcomes of triceps-sparing elbow arthroplasties: a systematic review

Total elbow arthroplasty (TEA) is a reconstructive option for fractures, arthritis, and tumors, particularly in older adults. Approaches for the procedure can be categorized into triceps-sparing (TS) or triceps-detaching (TD). TD approaches are well-studied, but are associated with many complications such as infections, limited range of motion, and triceps insufficiency. Despite being more technically demanding, TS approaches are rising in popularity due to preservation of the triceps insertion. This study consolidates the most recent literature on TS-TEAs and TS elbow hemiarthroplasties (EHAs) to better inform updated clinical decision-making.

A PROSPERO-registered systematic review was conducted on March 10, 2025, searching PubMed, Ovid-Embase, MEDLINE, and Web of Science for studies published since 2020 that investigate TS elbow arthroplasty findings in adults. Extracted outcomes included demographics, range of motion metrics, and complications. Frequency-weighted means, t-tests, and chi-square tests were accordingly utilized in R Studio for statistical analyses.

Eight moderate-quality retrospective studies were identified (5 TS-TEA and 3 TS-EHA) out of 290. Patients (n = 252; TS-TEA 195; TS-EHA 57) had average ages of 64.5 ± 12.5 and 73.1 ± 10.6, with average follow-ups of 43.8 ± 39.5 and 56.3 ± 20.0 months for TS-TEA and TS-EHA, respectively. Average flexion degrees were 129.7° ± 19.5 and 129.0° ± 13.8, followed by extension deficits at 17.9° ± 17.3 and 19.8° ± 12.9, respectively. Average postoperative prosupination arc ranges were 140.6°-144.6° and 155°-171°, respectively. Complication rates were 22.9% after TS-TEA and 54.4% after TS-EHA, characterized by literature-compared high rates of ulnar nerve symptoms and heterotopic ossification, but low rates of infection and triceps insufficiency.

TS approaches, either in TEA or EHA, are reasonable options for surgeons today. Further studies are recommended for more granular and consistent elucidation, with arthroplasty approaches remaining individualized to patient needs and surgeon preferences.