Robert P Dachs1, Mark A Fleming2, David A Chivers2, Henri R Carrara3, Jean-Pierre Du Plessis2, Basil C Vrettos2, Stephen J Roche2. 1. Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa. Electronic address: robdachs@gmail.com. 2. Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa. 3. Department of Medical Statistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Abstract
BACKGROUND: Total elbow arthroplasty (TEA) is associated with high complication rates compared with other large-joint arthroplasties. The frequency and type of complication may differ, depending on the surgical approach. A comparison of outcomes with triceps-off and triceps-on approaches was investigated. METHODS: Seventy-three patients underwent 83 primary TEAs between 2003 and 2012. Forty-six elbows had a triceps-off approach, and 37 had a triceps-on approach. Results were reviewed at a mean of 4.2 years. Cementing technique was graded according to Morrey's criteria, and clinical outcomes were assessed by means of the Mayo Elbow Performance Score. RESULTS: There was no statistically significant difference between the triceps-off and triceps-on groups with regard to the patient's age, gender, preoperative Mayo Elbow Performance Score or range of motion, or previous surgery on the affected elbow. Among patients who underwent a TEA for an inflammatory arthropathy, there was a significant difference in outcome between groups with regard to final flexion, extension, arc of motion, and pronation. Cementing technique in the triceps-off group was adequate in 70%. In the triceps-on group, cementing technique was adequate in 92%. The complication rate in the triceps-off group was 32.6% and included 7 triceps ruptures. Three patients who had attempted repairs of the triceps rupture developed deep infections requiring multiple further surgeries. The complication rate in the triceps-on group was 8.1%. CONCLUSION: A triceps-on approach in TEA results in consistently good clinical outcomes with no risk of triceps rupture, and the approach does not compromise the cement mantle. We believe that this approach will reduce complication rates in TEA.
BACKGROUND:Total elbow arthroplasty (TEA) is associated with high complication rates compared with other large-joint arthroplasties. The frequency and type of complication may differ, depending on the surgical approach. A comparison of outcomes with triceps-off and triceps-on approaches was investigated. METHODS: Seventy-three patients underwent 83 primary TEAs between 2003 and 2012. Forty-six elbows had a triceps-off approach, and 37 had a triceps-on approach. Results were reviewed at a mean of 4.2 years. Cementing technique was graded according to Morrey's criteria, and clinical outcomes were assessed by means of the Mayo Elbow Performance Score. RESULTS: There was no statistically significant difference between the triceps-off and triceps-on groups with regard to the patient's age, gender, preoperative Mayo Elbow Performance Score or range of motion, or previous surgery on the affected elbow. Among patients who underwent a TEA for an inflammatory arthropathy, there was a significant difference in outcome between groups with regard to final flexion, extension, arc of motion, and pronation. Cementing technique in the triceps-off group was adequate in 70%. In the triceps-on group, cementing technique was adequate in 92%. The complication rate in the triceps-off group was 32.6% and included 7 triceps ruptures. Three patients who had attempted repairs of the triceps rupture developed deep infections requiring multiple further surgeries. The complication rate in the triceps-on group was 8.1%. CONCLUSION: A triceps-on approach in TEA results in consistently good clinical outcomes with no risk of triceps rupture, and the approach does not compromise the cement mantle. We believe that this approach will reduce complication rates in TEA.
Authors: Qing Zhang; Ming Xiang; Hang Chen; Xiaochuan Hu; Yiping Li; Jinwen Zheng; Mingyue Deng Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Date: 2019-07-15
Authors: Andrew King; Jonathan P Evans; Simon J Booker; James Cs Beazley; Robin Js Jones; William Jc Thomas; Christopher Smith Journal: Shoulder Elbow Date: 2018-05-25
Authors: Danielle Meijering; Alexander L Boerboom; Carina L E Gerritsma; Bertram The; Michel P J van den Bekerom; Marco van der Pluijm; Riemer J K Vegter; Sjoerd K Bulstra; Denise Eygendaal; Martin Stevens Journal: BMJ Open Date: 2021-05-05 Impact factor: 2.692