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Triceps-sparing approach results in a better elbow function than a triceps-detaching approach in total elbow
Daniëlle Meijering1, Alexander L Boerboom1, Carina L E Gerritsma2
1Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Background:
New surgical approaches have been developed to optimize functional outcomes after total elbow arthroplasty (TEA). Historically, the triceps-detaching approach was predominantly used, involving partial release of the triceps tendon to improve surgical exposure, at the cost of a higher risk of post-operative extensor weakness. More recently, there has been a shift toward triceps-sparing techniques, in which the triceps tendon is preserved at the cost of limited articular visibility, possibly risking component malalignment. There is no consensus on the best surgical approach, and prospective studies are lacking. This study aims to investigate the functional outcomes, prosthetic component positioning, and complication rates after a triceps-sparing vs. a triceps-detaching approach in TEA.
Methods And Analysis:
A multicenter, prospective, comparative, non-randomized cohort study was conducted. All patients with an indication for primary TEA were enrolled in either a triceps-sparing or a triceps-detaching cohort. The primary outcome measure was elbow dysfunction, specified as fixed flexion deformity (FFD). Secondary outcome parameters were objectively measured physical functioning (including triceps force), self-reported physical functioning, prosthetic component positioning on standard radiographs, and complications. Data will be analyzed using multilevel modeling.
Results:
A total of 55 patients were included in each cohort; 46 patients were available for the 12-month follow-up in the triceps-sparing cohort and 47 patients in the triceps-detaching cohort. Baseline characteristics did not differ between the groups, except for sex. The mean FFD at 12 months was 12° in the triceps-sparing cohort and 26° in the triceps-detaching cohort (P < .01). Self-reported outcomes and prosthetic component positioning on radiographs did not differ significantly. Major surgery-related complication rates of up to 44% were reported, without significant differences between the groups. Infection, ulnar nerve dysfunction, fractures of the proximal ulna, and triceps insufficiency were most frequently reported.
Conclusion:
The triceps-sparing approach results in a significantly and clinically relevant better FFD and range of motion than the triceps-detaching approach. Patient-reported outcomes and prosthetic component positioning on radiographs are similar, and reported complication rates are high but comparable between the approaches.
