title: Total elbow arthroplasty: outcomes after triceps-detaching and triceps-sparing approaches.
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%.
  
  
  CONCLUSIONS
  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.affiliation: Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa. Electronic address: robdachs@gmail.com.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Dachs
authors.affiliation: Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Fleming
authors.affiliation: Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: David A
authors.initials: DA
authors.lastname: Chivers
authors.affiliation: Department of Medical Statistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Henri R
authors.initials: HR
authors.lastname: Carrara
authors.affiliation: Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Du Plessis
authors.affiliation: Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: Basil C
authors.initials: BC
authors.lastname: Vrettos
authors.affiliation: Department of Orthopaedic Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roche
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects / Q000379:methods*; D002484:Cementation; D004551:Elbow Joint; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000293:injuries / Q000601:surgery*; D059351:Organ Sparing Treatments; D010781:Photography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012421:Rupture / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Total elbow arthroplasty; complication; triceps rupture; triceps-on; triceps-sparing