Triceps-sparing approach results in better elbow function compared to triceps-detaching approach in total elbow arthroplasty: A multicenter prospective cohort study.

Abstract

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 postoperative 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 and a triceps-detaching approach in TEA. 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. 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 in standard radiographs, and complications. Data will be analyzed using multilevel modelling. A total of 55 patients were included in each cohort; 46 patients were available for 12 months follow-up in the triceps-sparing cohort and 47 patients in the triceps-detaching cohort. Baseline characteristics did not differ between groups, except for sex. Mean FFD at 12 months was 12° in the triceps-sparing cohort and 26° in the triceps-detaching cohort (p<0.01). Self-reported outcomes and prosthetic component positioning on radiographs did not differ significantly. Major surgery-related complication rates up to 44% were reported, without significant differences between groups. Infection, ulnar nerve dysfunction, fractures of the proximal ulna, and triceps insufficiency were most frequently reported. The triceps-sparing approach results in significant and clinically relevant better FFD and range of motion (ROM) 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 approaches. The trial has been registered in the Dutch Trial Register: NTR NL8488. Level II; Prospective Cohort Design; Treatment Study.