A Clinical Comparison of Triceps-Sparing and Triceps-Detaching Approaches for Revision Total Elbow Arthroplasty

Abstract

Triceps-sparing (TS) approaches have been reported to provide improved triceps strength, better patient outcomes, and a lower incidence of complications in primary total elbow arthroplasty (TEA). It remains unclear whether the advantages of this approach are similar in the revision setting, especially in cases with prior triceps detachment. The purpose of this study was to compare triceps strength and clinical outcomes between TS and triceps-detaching (TD) approaches in revision TEA. All revision TEAs performed over a 17-year period with a minimum 1-year follow-up were retrospectively reviewed. Elbows with preoperative triceps insufficiency or subsequent component removal for infection were excluded. Patients were grouped according to the surgical approach performed at the last revision TEA. Outcome measures included triceps strength, range of motion, visual analog scale (VAS), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Ten TS and 6 TD elbows were evaluated. Four elbows within the TS group had documented TD surgery prior to revision. Median follow-up was longer in the TD group (137 ± 75 months vs 53 ± 20 months). Functional strength and DASH scores were significantly better in the TS group. Arc of motion, VAS, and MEPS were similar between the TS and the TD groups. The TS approach preserves greater postoperative functional triceps strength after revision TEA, regardless of the type of approach used previously. Therapeutic V.