title: The lateral para-olecranon approach for total elbow arthroplasty.
abstract: OBJECTIVE
  To describe and evaluate the lateral para-olecranon approach for total elbow arthroplasty and to compare it with the paratricipital and triceps splitting approaches.
  
  
  METHODS
  A total of 34 patients who underwent total elbow arthroplasty were evaluated: 25 with rheumatoid arthritis (28 elbows) and 9 with fractures. The average duration of follow-up was 54 months (range, 12-105 mo). Of the 28 elbows with rheumatoid arthritis, 17 underwent a triceps splitting approach, 6 a lateral para-olecranon, and 5 a paratricipital approach. Of the 9 fracture cases, 5 patients underwent a lateral para-olecranon and 4 a paratricipital approach. Extension strength, range of motion, elbow function (Mayo Elbow Performance Index), and complications related to triceps insufficiency were compared for all 3 approaches. In addition, we compared triceps strength after lateral para-olecranon and paratricipital approaches with the contralateral healthy elbow in the 9 fracture cases.
  
  
  RESULTS
  Patients with rheumatoid arthritis had better extension torque when the prosthesis was implanted through the lateral para-olecranon approach (20 ± 8 N-m) compared with the triceps splitting (13 ± 4 N-m) or paratricipital approaches (12 ± 6 N-m). In the fracture group, the extension strength of the replaced elbow was similar to the contralateral normal elbow in both the paratricipital and lateral para-olecranon groups.
  
  
  CONCLUSIONS
  The lateral para-olecranon approach avoids triceps tendon detachment from and repair to the olecranon, thereby reducing the risk of triceps insufficiency while maintaining better extension strength relative to a triceps splitting approach.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Hand and Upper Limb Centre, St. Joseph's Healthcare London, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada. Electronic address: alexis@studer.net.
authors.forename: Alexis
authors.initials: A
authors.lastname: Studer
authors.forename: George S
authors.initials: GS
authors.lastname: Athwal
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Faber
authors.forename: Graham J W
authors.initials: GJ
authors.lastname: King
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000601:surgery*; D057929:Arthroplasty, Replacement, Elbow / Q000379:methods*; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D013536:Suture Techniques; D016896:Treatment Outcome; D000092464:Elbow Injuries
keywords: Total elbow arthroplasty; paratricipital approach; surgical approach; triceps insufficiency; triceps-splitting approach