A modified posterior approach to the elbow for total elbow replacement

Unlinked and convertible total elbow arthroplasty

Total elbow arthroplasty (TEA) is still in its infancy if we compare it with other arthroplasties such as knee or hip. TEA designs have been evolving with experience; however, long-term outcome data remain limited. The designs of total elbow prostheses can be subdivided into 3 general categories: unlinked, linked, and convertible devices. This article focuses on unlinked and convertible prostheses.

The triceps-preserving approach for semiconstrained total elbow arthroplasty

Total elbow arthroplasty (TEA) is a useful tool to relieve pain and provide return to function for many conditions affecting the elbow. For conditions ranging from inflammatory arthropathies to comminuted intra-articular distal humeral fractures in the elderly, TEA is an excellent treatment alternative. Numerous surgical approaches for TEA have been described. Most surgeons use either a direct posterior or posterior-lateral incision. TEA is not without its complications. One such complication is insufficiency of the triceps. Many surgical approaches have been described to try to decrease the possibility of triceps insufficiency. In this article, we describe a new technique not previously described in which, using a posterior incision, the triceps is only dissected from the medial side. With this technique, the tendon insertion on the olecranon, as well as the entire lateral soft-tissue envelope of the elbow, is left undisturbed.

Biomechanical properties of triceps brachii tendon after in vitro simulation of different posterior surgical approaches

Total elbow arthroplasty is usually performed through a triceps-reflecting or -preserving approach. Weakness of extension is common. The purpose of this study was to compare the in vitro mechanical properties of the triceps tendon after simulation of 3 common exposures. After simulation of the approach and repair, cadaveric specimens were mounted on a material testing system and a constant velocity elongation was applied. The contralateral elbow served as the control. All approaches resulted in a marked weakening of the triceps; however, the Bryan-Morrey lateral triceps-reflecting technique provided statistically better strength than V-Y or longitudinal splitting.